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University  of  California  •  Berkeley 


Regional  Oral  History  Office  University  of  California 

The  Bancroft  Library  Berkeley,  California 

University  History  Series 
School  of  Public  Health  Oral  Histories 


Henrik  Blum,  M.D.,  M.P.H. 

EQUITY  FOR  THE  PUBLIC'S  HEALTH:  CONTRA  COSTA  HEALTH  OFFICER; 
PROFESSOR,  UC  SCHOOL  OF  PUBLIC  HEALTH;  WHO  FIELDWORKER 


With  an  Introduction  by 
Dr.  William  C.  Reeves 


Interviews  Conducted  by 

Caroline  Crawford 

in  1997 


Copyright  ©  1999  by  The  Regents  of  the  University  of  California 


Since  1954  the  Regional  Oral  History  Office  has  been  interviewing  leading 
participants  in  or  well-placed  witnesses  to  major  events  in  the  development  of 
Northern  California,  the  West,  and  the  Nation.  Oral  history  is  a  method  of 
collecting  historical  information  through  tape-recorded  interviews  between  a 
narrator  with  firsthand  knowledge  of  historically  significant  events  and  a  well- 
informed  interviewer,  with  the  goal  of  preserving  substantive  additions  to  the 
historical  record.  The  tape  recording  is  transcribed,  lightly  edited  for 
continuity  and  clarity,  and  reviewed  by  the  interviewee.  The  corrected 
manuscript  is  indexed,  bound  with  photographs  and  illustrative  materials,  and 
placed  in  The  Bancroft  Library  at  the  University  of  California,  Berkeley,  and  in 
other  research  collections  for  scholarly  use.  Because  it  is  primary  material, 
oral  history  is  not  intended  to  present  the  final,  verified,  or  complete 
narrative  of  events.  It  is  a  spoken  account,  offered  by  the  interviewee  in 
response  to  questioning,  and  as  such  it  is  reflective,  partisan,  deeply  involved, 
and  irreplaceable. 


************************************ 


All  uses  of  this  manuscript  are  covered  by  a  legal  agreement 
between  The  Regents  of  the  University  of  California  and  Henrik  Blum 
dated  May  1,  1997.  The  manuscript  is  thereby  made  available  for 
research  purposes.  All  literary  rights  in  the  manuscript,  including 
the  right  to  publish,  are  reserved  to  The  Bancroft  Library  of  the 
University  of  California,  Berkeley.  No  part  of  the  manuscript  may 
be  quoted  for  publication  without  the  written  permission  of  the 
Director  of  The  Bancroft  Library  of  the  University  of  California, 
Berkeley. 

Requests  for  permission  to  quote  for  publication  should  be 
addressed  to  the  Regional  Oral  History  Office,  486  Library, 
University  of  California,  Berkeley  94720,  and  should  include 
identification  of  the  specific  passages  to  be  quoted,  anticipated 
use  of  the  passages,  and  identification  of  the  user.  The  legal 
agreement  with  Henrik  Blum  requires  that  he  be  notified  of  the 
request  and  allowed  thirty  days  in  which  to  respond. 

It  is  recommended  that  this  oral  history  be  cited  as  follows: 


Henrik  Blum,  M.D.,  M.P.H.,  "Equity  for  the 
Public's  Health:  Contra  Costa  Health 
Officer;  Professor,  UC  School  of  Public 
Health;  WHO  Fieldworker, "  an  oral  history 
conducted  in  1997  by  Caroline  Crawford, 
Regional  Oral  History  Office,  The  Bancroft 
Library,  University  of  California, 
Berkeley,  1999. 


Copy  no. 


Dr.  Henrik  Blum,  Professor  of  Health  Planning  and  Policy, 
UCB,  1984;  Chairman  of  HEALS  HMO,  Chairman  of  Alta  Bates 
Hospital. 


Cataloging  information 


BLUM,  Henrik  L.  (b.  1915)  Public  health  educator 

Equity  for  the  Public's  Health:  Contra  Costa  Health  Officer;  Professor.  UC 
School  of  Public  Health;  WHO  Fieldworker.   1999,  xii,  425  pp. 

Growing  up  on  a  farm  in  Napa;  UC  Berkeley,  1931-1937;  UC  San  Francisco 
Medical  School,  1942;  military  service,  1942-1946,  US  Public  Health 
Service:  venereal  disease  research  projects,  faculty  position  at  Johns 
Hopkins;  Rockefeller  Research  Fellow,  Stanford;  M.P.H.,  Harvard,  1948; 
County  Health  Officer,  Contra  Costa  County,  1950-1966:  the  multipurpose 
healthcare  worker,  sanitation,  mental  health,  birth  control,  the  Orinda 
Vision  Study;  Professor,  School  of  Public  Health,  UC  Berkeley,  1966-1984: 
health  planning  curriculum,  affirmative  action,  authoring  health  planning 
texts,  Joint  UCB-UCSF  Medical  Program;  Alta  Bates  and  Herrick  Hospitals, 
HEALS  HMO,  thoughts  about  managed  care;  international  fieldwork  with  the 
World  Health  Organization  in  Sri  Lanka,  Colombia,  Chile,  1970-1973;  with 
the  Agency  for  International  Development  in  Nepal,  1977;  health  care  in 
Europe  and  Australia,  American  Samoa  and  Northern  Marianas;  Fulbright 
teaching  fellow  in  Sweden,  1986;  teaching  health  planning  in  China,  1987; 
Over  60  and  On  Lok  health  programs. 

Introduction  by  Dr.  William  C.  Reeves,  Professor  emeritus,  UC 
Berkeley  School  of  Public  Health. 

Interviewed  by  Caroline  C.  Crawford  in  1997  for  the  School  of  Public 
Health  Oral  History  Series.   Regional  Oral  History  Office,  The 
Bancroft  Library,  University  of  California,  Berkeley. 


ACKNOWLEDGMENTS 


The  School  of  Public  Health  and  the  Regional  Oral  History  Office,  on 
behalf  of  future  researchers,  wishes  to  thank  the  following  individuals  and 
organizations  whose  contributions  made  possible  this  oral  history  of  Henrik 
Blum. 


Anita  Addison 
Balan  and  Gurdeep  Arakoni 
Katherine  Armstrong 
Richard  Bailey 
Willa  Baum 
Cheryl  Belcourt 
Joan  and  Howard  Bloom 
Sandra  and  John  Boeschen 
Patricia  and  Richard  Buffler 
Chin  Long  and  Fu  Chen  Chiang 
Joanna  Ciaglia 
Sylvia  De  Trinidad 
Anne  Donnelly 
Eleanor  Fletcher 
FMC  Foundation 
David  and  Sylvia  Frost 
Margaret  Hall 
Judith  Hibbard 
Pat  and  Harry  Hosel 
Sharron  Humenick 
Carlessia  Hussein 
Lucy  Johns 

Donald  and  Inez  Johnson 
Olive  Johnson 
Kaiser  Pennanente 
Barry  Kaplan 
Jane  Kenyon 
Margo  Kerrigan 
Kathryn  and  Niels  Kjellund 
Joyce  and  Richard  Lashof 
Dan  Lindheim 

Richard  and  Roselyn  Lindheim 
Memorial  Trust 


Susan  Lindheim 

James  Lubben 

Merle  Lustig 

Dextra  Baldwin  McGonagle 

Foundation 
George  McKray 

Donald  and  Elizabeth  Minkler 
Meredith  Minkler 
Patricia  Mullen 
Ed  Nathan 
Thomas  Novotny 
Dorothy  Nyswander 
Martyann  Penberth-Valentine 
Janet  Perlman 

Mary  Pittman  and  David  Lindeman 
Nancy  Presson 
Florence  and  Paul  Raskin 
William  and  Mary  Jane  Reeves 
Joseph  and  Nancy  Restuccia 
Frances  Saunders 
George  and  Linda  Sensabaugh 
Sandra  Shewry 
Takeo  Shirasawa 
Ralph  Silber 
Rosalind  Singer 
Harvey  Smith 
Shoshanna  Sofaer 
Lucia  and  Peter  Sommers 
Sandra  Stein-Starr 
Mary  Stevens 
S.  Leonard  Syme 
David  Taylor 
Cheryl  Wyborny 
Ruth  Young 


TABLE  OF  CONTENTS- -Henrik  Blum 

PREFACE  by  Patricia  A.  Buffler  i 

INTRODUCTION  by  William  C.  Reeves  v 

INTERVIEW  HISTORY  xi 

BIOGRAPHICAL  INFORMATION  xiii 


I  FAMILY  HISTORY,  CHILDHOOD  AND  EDUCATION:  1915-1934  1 
Caveats  and  Oral  History  1 
Wartime  Experiment  Using  Human  Guinea  Pigs  3 
Parents  and  Childhood  in  Napa  12 
The  Community  in  Petaluma  and  Farming  in  Coombsville  15 
Schooling  23 
High  School  Egalitarianism  and  Elitism  27 
The  Depression  Years  35 
Music  Studies  and  Cultural  Exposure  41 

II  COMING  TO  UC  BERKELEY:  UNDERGRADUATE  STUDIES,  1931-1937  45 
From  Engineering  to  Chemistry  45 
Perry  R.  Stout  and  Daniel  Arnon:  Mentors  49 
Choosing  a  Career  54 

III  UNIVERSITY  OF  CALIFORNIA  MEDICAL  SCHOOL:  1938-1942  57 
Happy  Jack:  Starting  Medical  School  and  Finding  Housing  57 
Chauncey  Leake  and  Pharmacology  59 
Being  a  Pain  in  the  Neck  in  Pathology  in  Our  Second  Year  60 
Housing  During  Medical  School  62 
Obstetrics  at  San  Francisco  General  64 
Treating  the  Poor  and  Thoughts  of  a  Career  in  Public  Health  69 
More  About  Medical  School  and  Student  Activism  78 

IV  SERVING  IN  THE  U.S.P.H.S.  IN  WORLD  WAR  II--PART  OF  THE  ARMED 

SERVICES:  1942-1946  80 

An  Internship  at  the  Marine  Hospital  in  San  Francisco  and  a  Brief 

Stint  at  a  Venereal  Disease  Hospital  in  Arkansas  80 

A  VD  Research  Project  at  the  Penitentiary  in  Terre  Haute,  Indiana      83 

Applying  to  the  Regular  Corps  89 

A  Faculty  Position  at  Johns  Hopkins  University  Medical  School  90 

Assignment  to  San  Diego  101 

Going  AWOL:  Back  Surgery  at  the  San  Francisco  Marine  Hospital  107 

V  RESIDENCY  AT  STANFORD  AND  ON  TO  HARVARD:  1946-1948  110 
Treating  and  Studying  Syphilis  110 
Harvard  University  and  the  School  of  Public  Health  118 
A  Special  Bostonian  Family  122 


VI  SETTLING  IN  CALIFORNIA- -CONTRA  COSTA  COUNTY:  1950-1966  126 
The  California  State  Health  Department:  A  Year  in  San  Diego,  and 

on  to  Contra  Costa  County  126 

Serving  as  County  Health  Officer  in  Contra  Costa  County  130 

Expanding  the  Budget  and  the  Department:  Testing  for  TB  134 

Signing  Off  on  Septic  Problems  138 

The  County  Hospital  and  George  Degnan  140 

Sanitation  Problems  and  County  Restaurants  146 

Labor  and  Industry  Politics:  Tidewater  Oil  156 
Growing  Wild  in  Contra  Costa:  More  about  Sewers  and  Other 

Amenities  158 

A  Privately  Owned  Development;  A  Municipal  Utility  District  168 
Dealing  with  the  AEC  and  other  Federal  and  State  Watchdog  Agencies  171 

Anne  Leslie:  "Office  Wife"  172 

The  Civil  Service  and  Other  Frustrations  173 
More  about  the  Mental  Health  Program,  and  Serving  with  the 

Space  Cadets:  1956-1965  176 

Being  Considered  for  a  Faculty  Position  at  Harvard  181 
Co-Authoring  a  Book  about  Administration:  1963;  A  Housing 

Project  in  East  St.  Louis;  Lincoln  Hospital  in  New  York  184 

Funding  for  Navajo  Projects  187 

The  Multipurpose  Worker  and  the  Rodeo  Center:  1964  188 
Studying  Health  Care  Systems  in  Europe  on  a  1962  WHO  Fellowship 

and  a  Later  Study  of  Health  Care  in  Australia  193 

Birth  Control  Programs  and  Governor  Pat  Brown  202 

Elizabeth  Jolly  and  the  Crippled  Children's  Program  212 

Training  Peace  Corps  Volunteers:  1964  215 
Other  Streams:  Creating  Air  Pollution  Control  Legislation  (1955) 

and  the  John  F.  Kennedy  University  (1964);  the  Orinda  Vision 

Study  (1959)  218 

Business  Activities  in  Contra  Costa  County  233 

A  House  in  Berkeley  236 

VII  MOVING  TO  BERKELEY:  THE  UNIVERSITY  AND  OTHER  INVOLVEMENTS: 

1966-1984  240 

Joining  the  University  of  California  Faculty  and  a  Campus  Revolt  240 

Job  Offers  from  Stanford,  New  York  City,  and  Los  Angeles  Health  243 
A  Joint  Masters  Program:  Department  of  City  and  Regional  Planning 

and  Health  Planning:  Collaboration  with  Nathan  Glaser  245 
A  First  Course  in  Health  Planning,  1967,  and  New  Legislation: 

The  89th  Congress,  1966  248 
A  1968  Planning  Grant  from  the  USPHS;  a  Program  for  Minorities  and 

Native  Americans;  Abandoning  Our  Marvelous  Planning  Grant  256 

Pressure  to  Publish,  Public  Administration,  and  Alex  Meiklejohn  267 

Building  a  Planning  Faculty  269 

Serving  on  Committees  of  the  Academic  Senate  272 

Thoughts  about  Teaching  and  W.C.  Fields  275 

American  Public  Health  Association  Involvements  in  the  1960s  277 

Advising  Governor  Reagan--Greed  is  Great:  1967  280 
Planning  for  Health  and  Expanding  Health  Care  Horizons.  Two 

Textbooks:  1974,  1976  "  282 

The  Hospital  World:  Alta  Bates  and  Herrick  Hospitals  and  HEALS  290 


VIII  INTERNATIONAL  FIELD  SERVICE:  1969-1981  307 
Dr.  Hilleboe  and  the  World  Health  Organization  307 
Working  with  WHO  in  Sri  Lanka:  1970  310 
WHO  and  a  Planning  Handbook  324 
Assignments  in  South  America  with  the  Pan  American  Health 

Organization  325 

A  USAID  Project  in  Nepal  333 

Planning  in  Color  Country,  Utah  340 
A  Keynote  Speech  on  Prevention  in  Paris:  1982,  Courtesy  of  the 

Drug  Companies;  A  Contrast,  Consulting  for  MDI  344 

Fieldwork  in  Three  Pacific  Islands  and  Yemen,  1980  347 

A  Fulbright  Award  in  Sweden  (1986)  and  Thoughts  about  Fieldwork  354 

Teaching  Health  Planning  in  Chengdu,  China,  1987  361 

IX  THE  1980s  AND  1990s  363 
Reviving  the  Joint  Medical  Program  363 
Ronnie  London  and  Maggie  Hall  368 
The  Over  60  and  On  Lok  Programs  and  Managed  Care  371 
A  Hypothetical  Health  Care  Study  381 
Awards  and  Afterthoughts  385 
Reflections  on  a  University  Career  391 
A  Sweet  Finale  394 

TAPE  GUIDE  395 

SAMPLE  EDITED  AND  INSERTED  PAGES  398 

APPENDIX 

A   Henrik  Blum  Curriculum  Vitae,  1994  400 

B   University  of  California  Oral  History  Series  List  408 

INDEX  420 


PREFACE  by  Patricia  A.  Buffler 


It  is  a  pleasure  to  introduce  the  University  of  California  School 
of  Public  Health  Oral  Histories  which  highlights  contributions  of  Public 
Health  faculty  members  to  the  health  and  well  being  of  populations  in 
California  and  worldwide  through  their  teaching,  research,  and  other 
scholarly  activities. 

The  idea  of  an  oral  history  series  in  Public  Health  was  proposed 
in  1993  with  the  successful  completion  of  the  oral  history  of  William 
Reeves,  the  fourth  public  health  faculty  member  to  participate  in  the 
Regional  Oral  History  Office  program  of  The  Bancroft  Library. 

The  foundations  of  the  School  of  Public  Health  date  back  to  the 
beginning  of  the  twentieth  century  when  the  University  of  California  and 
Stanford  University  initially  collaborated  on  a  graduate  curriculum  in 
public  health.   Subsequently  in  response  to  the  urgent  need  for  more 
public  health  professionals  in  the  Western  United  States,  the  1943 
California  State  Legislature  and  Governor  Earl  Warren  enacted  into  law  a 
bill  mandating  the  creation  of  the  first  school  of  public  health  west  of 
the  Mississippi  River.   The  school  was  established  at  the  University  of 
California,  Berkeley,  where  public  health  had  its  origins  more  than  two 
decades  earlier  with  the  creation  in  1917  of  a  Program  in  Hygiene  in  the 
Department  of  Zoology. 

Since  its  founding,  the  UC  Berkeley  School  of  Public  Health  has 
become  one  of  the  world's  preeminent  centers  dedicated  to  the  promotion 
and  protection  of  the  health  of  human  populations,  and  noted  for  the 
excellence  of  its  programs  in  teaching,  research,  and  service.   These 
programs,  grounded  in  an  understanding  of  theory  and  mechanisms  of  the 
basic  sciences,  are  integrated  through  a  focus  on  communities  that  reach 
from  Berkeley's  surrounding  neighborhoods  to  settings  around  the  world. 

For  example,  encephalitis  was  largely  suppressed  because  of  the 
work  of  Professors  William  Reeves  and  James  Hardy;  Dean  Charles  E. 
Smith's  pioneering  studies  of  coccidioidomycosis  (Valley  Fever)  resulted 
in  the  development  of  a  vaccine  for  the  disease;  and  Professor  Dorothy 
Bird  Nyswander's  contributions  in  public  health  education  and 
administration  are  renowned  both  nationally  and  internationally  in  the 
areas  of  family  planning,  school  health,  and  prevention  and  eradication 
of  malaria. 

The  tradition  continues  with  teaching  and  research  in  such  areas 
as  AIDS,  cancer,  violence,  infant  mortality,  the  toxicity  of  industrial 
waste,  tobacco-related  diseases,  human  genetics,  health  care  financing 
and  delivery  systems,  reproductive  health,  infectious  diseases,  and  the 
impact  of  media  on  behavior. 


ii 


Today,  the  School  of  Public  Health  at  Berkeley  enrolls 

approximately  475  students  annually-- 13  percent  from  other  countries  and 
approximately  25  percent  from  diverse  minority  cultures  within  the 
United  States. 

The  School  of  Public  Health  faculty  is  drawn  from  a  variety  of 
disciplines,  including  epidemiology,  biology,  economics,  political 
science,  anthropology,  and  chemistry,  and  from  professional  fields  such 
as  medicine,  engineering,  business,  and  social  work.   Faculty 
distinctions  include  six  American  Association  for  the  Advancement  of 
Science  Fellows,  three  Fulbright  Scholars,  five  members  of  the  National 
Academy  of  Sciences,  Institute  of  Medicine;  and  advisory  appointments  to 
the  Centers  for  Disease  Control,  the  National  Institutes  of  Health,  and 
the  World  Health  Organization. 

Over  the  past  fifty-five  years,  Berkeley  has  consistently  been  on 
the  cutting  edge  with  innovative  programs  including: 

-The  Health  and  Medical  Sciences  UCB/UCSF  Joint  Medical  Program, 

which  was  established  twenty-five  years  ago  as  an  alternative  to 

the  traditional  four-year  medical  school  located  in  a  medical 

center  complex.   Medical  students  at  Berkeley  not  only  complete 

their  preclinical  training  on  the  Berkeley  campus  but  are 

introduced  to  medical  care  in  a  variety  of  community  settings  and, 

by  committing  an  additional  year,  also  earn  a  Master  of  Science 

degree ; 

-A  long  standing  progressive  teaching  program  in  Maternal  and 

Child  Health,  which  since  1955  has  prepared  over  900  specialists 

in  Maternal  and  Child  Health  with  a  strong  research  and 

professional  practice  orientation; 

-A  nationally  recognized  and  model  field  training  program  for 

public  health  students,  which  ensures  an  academically  supervised 

internship  for  all  professional  students  seeking  to  earn  a  Master 

of  Public  Health  degree; 

-The  American  Indian  Graduate  Program,  which  has  trained  about  200 

Indian/Alaskan  natives  from  over  eighty  tribes  since  its  inception 

in  1971; 

-Centers  of  excellence  in  research  and  service,  including  the 

Prevention  Research  Center  for  Family  and  Community  Health,  the 

Center  for  Health  Management  Studies,  the  Northern  California 

Center  for  Occupational  and  Environmental  Health,  and  the  Center 

for  Children  and  the  Environment; 

-A  mission  statement  which  incorporates  a  commitment  to  human 

rights  and  multicultural  perspectives,  the  first  school  of  public 

health  to  do  so;  and 

-A  sponsored  research  and  research  training  portfolio  which  today 

exceeds  $25  million  and  amounts  to  more  than  $500,000  per  ladder 

rank  faculty  member,  ranking  the  school  among  the  most  productive 

and  extramurally  well-funded  units  on  the  Berkeley  campus. 


Ill 


The  oral  history  of  Professor  Henrik  Blum  is  the  seventh  in  the 
Public  Health  Series  following  volumes  by  six  early  faculty  members: 
Karl  F.  Meyer  and  his  research  on  zoonotic  diseases  of  public  health 
significance,  Jessie  Bierman  and  her  research  on  maternal  and  child 
health,  Sanford  Elberg  and  his  research  on  brucellosis,  William  Reeves 
and  his  studies  of  arthropod-borne  encephalitides,  Dorothy  Nyswander  and 
her  international  work  in  health  education,  and,  still  in  process, 
Warren  Winkelstein  who  was  one  of  several  pioneering  investigators  in 
the  San  Francisco  AIDS  epidemic  in  the  1980s.   The  oral  history  of 
Henrik  Blum  represents  a  unique  contribution  to  this  series  with  its 
emphasis  on  health  planning,  community  development,  and  humanism  in 
medical  and  public  health  education. 

During  its  distinguished  history  the  school  has  undergone 
successfully  several  transitions.   The  evolution  of  public  health 
education  and  the  need  for  these  transitions  are  well  illustrated  in  the 
careers  of  faculty  who  provided  leadership  during  these  critical  times. 

The  leadership  and  vision  of  the  public  health  faculty  is  evident 
in  all  of  these  oral  histories.   These  true  pioneers  anticipate  not  just 
the  health  problems  consequent  with  certain  conditions,  but  new 
solutions  to  these  problems.   The  lives  and  careers  of  these  faculty 
members  provide  a  rich  account  of  the  history  of  public  health  and 
public  health  education  in  California. 

Patricia  A.  Buffler 

Dean  Emerita  and  Professor  of  Public 
Health  Epidemiology 

February  1999 
School  of  Public  Health 
University  of  California 
Berkeley,  California 


ii 


Today,  the  School  of  Public  Health  at  Berkeley  enrolls 

approximately  475  students  annually-- 13  percent  from  other  countries  and 
approximately  25  percent  from  diverse  minority  cultures  within  the 
United  States. 

The  School  of  Public  Health  faculty  is  drawn  from  a  variety  of 
disciplines,  including  epidemiology,  biology,  economics,  political 
science,  anthropology,  and  chemistry,  and  from  professional  fields  such 
as  medicine,  engineering,  business,  and  social  work.   Faculty 
distinctions  include  six  American  Association  for  the  Advancement  of 
Science  Fellows,  three  Fulbright  Scholars,  five  members  of  the  National 
Academy  of  Sciences,  Institute  of  Medicine;  and  advisory  appointments  to 
the  Centers  for  Disease  Control,  the  National  Institutes  of  Health,  and 
the  World  Health  Organization. 

Over  the  past  fifty-five  years,  Berkeley  has  consistently  been  on 
the  cutting  edge  with  innovative  programs  including: 

-The  Health  and  Medical  Sciences  UCB/UCSF  Joint  Medical  Program, 

which  was  established  twenty-five  years  ago  as  an  alternative  to 

the  traditional  four-year  medical  school  located  in  a  medical 

center  complex.   Medical  students  at  Berkeley  not  only  complete 

their  preclinical  training  on  the  Berkeley  campus  but  are 

introduced  to  medical  care  in  a  variety  of  community  settings  and, 

by  committing  an  additional  year,  also  earn  a  Master  of  Science 

degree; 

-A  long  standing  progressive  teaching  program  in  Maternal  and 

Child  Health,  which  since  1955  has  prepared  over  900  specialists 

in  Maternal  and  Child  Health  with  a  strong  research  and 

professional  practice  orientation; 

-A  nationally  recognized  and  model  field  training  program  for 

public  health  students,  which  ensures  an  academically  supervised 

internship  for  all  professional  students  seeking  to  earn  a  Master 

of  Public  Health  degree; 

-The  American  Indian  Graduate  Program,  which  has  trained  about  200 

Indian/Alaskan  natives  from  over  eighty  tribes  since  its  inception 

in  1971; 

-Centers  of  excellence  in  research  and  service,  including  the 

Prevention  Research  Center  for  Family  and  Community  Health,  the 

Center  for  Health  Management  Studies,  the  Northern  California 

Center  for  Occupational  and  Environmental  Health,  and  the  Center 

for  Children  and  the  Environment; 

-A  mission  statement  which  incorporates  a  commitment  to  human 

rights  and  multicultural  perspectives,  the  first  school  of  public 

health  to  do  so;  and 

-A  sponsored  research  and  research  training  portfolio  which  today 

exceeds  $25  million  and  amounts  to  more  than  $500,000  per  ladder 

rank  faculty  member,  ranking  the  school  among  the  most  productive 

and  extramurally  well-funded  units  on  the  Berkeley  campus. 


Ill 


The  oral  history  of  Professor  Henrik  Blum  is  the  seventh  in  the 
Public  Health  Series  following  volumes  by  six  early  faculty  members: 
Karl  F.  Meyer  and  his  research  on  zoonotic  diseases  of  public  health 
significance,  Jessie  Bierman  and  her  research  on  maternal  and  child 
health,  Sanford  Elberg  and  his  research  on  brucellosis,  William  Reeves 
and  his  studies  of  arthropod-borne  encephalitides,  Dorothy  Nyswander  and 
her  international  work  in  health  education,  and,  still  in  process, 
Warren  Winkelstein  who  was  one  of  several  pioneering  investigators  in 
the  San  Francisco  AIDS  epidemic  in  the  1980s.   The  oral  history  of 
Henrik  Blum  represents  a  unique  contribution  to  this  series  with  its 
emphasis  on  health  planning,  community  development,  and  humanism  in 
medical  and  public  health  education. 

During  its  distinguished  history  the  school  has  undergone 
successfully  several  transitions.   The  evolution  of  public  health 
education  and  the  need  for  these  transitions  are  well  illustrated  in  the 
careers  of  faculty  who  provided  leadership  during  these  critical  times. 

The  leadership  and  vision  of  the  public  health  faculty  is  evident 
in  all  of  these  oral  histories.   These  true  pioneers  anticipate  not  just 
the  health  problems  consequent  with  certain  conditions,  but  new 
solutions  to  these  problems.   The  lives  and  careers  of  these  faculty 
members  provide  a  rich  account  of  the  history  of  public  health  and 
public  health  education  in  California. 

Patricia  A.  Buffler 

Dean  Emerita  and  Professor  of  Public 
Health  Epidemiology 

February  1999 
School  of  Public  Health 
University  of  California 
Berkeley,  California 


iv 


February  1999 


University  History  Series 
School  of  Public  Health  Oral  Histories 


Jessie  Bierman,  M.D.  (1900-1996) 

Maternal  and  Child  Health  in  Montana,  California, 
the  U.S.  Children's  Bureau,  and  WHO.  1926-1967, 
1987. 

Henrik  L.  Blum,  M.D.  and  M.P.H.  (b.  1915) 

Equity  for  the  Public's  Health:  Contra  Costa 
Health  Officer;  Professor.  UC  School  of  Public 
Health;  WHO  Fieldworker.  1999. 

Sanford  S.  Elberg,  Ph.D.  (b.  1913) 

Graduate  Education  and  Microbiology  at  the 
University  of  California. Berkeley,  1930-1989, 
1990. 

Karl  F.  Meyer,  Dr.  Med.  Vet.,  Ph.D.  (1884-1974) 
Medical  Research  and  Public  Health. 
1976 

Dorothy  B.  Nyswander,  Ph.D.  (1894-1998) 

Professor  and  Activist  for  Public  Health 
Education  in  the  Americas  and  Asia.  1994 

William  C.  Reeves,  Ph.D.  (b.  1916) 

Arbovirologist  and  Professor.  UC  Berkeley 
School  of  Public  Health.  1993. 


Pediatrician; 

professor; 

public  health 

administrator 

Health  planner, 

administrator, 

professor 


Microbiologist ; 

professor 

and  administrator 


Epidemiologist ; 
Director,  Hooper 
Foundation,  UCSF 

Public  health 

professor  and 

educator 

Epidemiologist ; 

Professor,  UC  Berkeley 

School  of  Public  Health 


INTRODUCTION  by  William  C.  Reeves 


When  I  was  asked  to  prepare  an  introduction  to  Henrik  Blum's  oral 
history,  I  wondered  if  our  frequent  but  usually  casual  associations  for 
forty-plus  years  would  be  an  adequate  base  of  operations.   Then,  I 
decided:  What  the  hell,  if  The  Bancroft  Library  staff  and  Henrik  want  me 
to  do  it,  I'll  do  it.   It  should  be  fun  and  it  will  reload  my  memory 
bank.   I  can  play  the  role  of  a  fan  on  the  sidelines  watching  a  star 
play  the  health  planning  game,  a  star  who  over  his  career  has  improved 
the  health  of  people  throughout  the  world.   This  was  not  an  easy  task  to 
take  on,  but  one  worth  doing.   I  was  given  an  opportunity  to  read  drafts 
of  several  chapters  of  Henrik 's  opus  and  as  I  expected,  I  found  that  he 
has  called  a  spade  a  spade,  is  fair  in  his  judgments  about  the  character 
of  other  players  in  the  game,  and  has  given  damnation  or  praise  as  it 
was  earned. 

Henrik  Blum's  early  life  was  spent  on  a  farm  in  the  Napa  Valley  of 
California.   Many  of  his  views  still  reflect  the  imprint  left  on  him 
from  growing  up  during  the  economic  Depression  of  the  1930s.   He  was 
exposed  to  high  standards  of  honesty,  and  learned  how  to  use  direct 
approaches  to  solve  problems.   He  also  discovered  the  need  to  evaluate 
the  character  and  competence  of  associates  and  not  to  yield  to  the 
ethnic  prejudices  and  other  biases  that  still  prevail  in  most 
communities  almost  seventy  years  later.   As  an  undergraduate  at  Berkeley 
he  was  fortunate  enough  to  meet  and  wed  Marian  H.  Ehrich.   They  have 
spent  almost  sixty  years  together  as  loving  partners,  sharing  career  and 
home  changes,  worldwide  travels,  and  a  deep  love  of  music  and  the  arts. 
Whenever  I  comment  to  Henrik  on  his  unusual  capacity  to  judge  the 
character  or  competence  of  people,  he  tells  me  he  is  an  amateur  compared 
to  Marian.   She  has  been  a  remarkable  person  with  whom  to  share  and 
enjoy  life. 

Recruiting  Henrik  to  the  faculty  of  the  School  of  Public  Health  in 
the  early  1950s  was  no  big  problem.   At  that  time,  the  epidemiology 
faculty  was  very  small.   The  number  of  courses  was  very  few  and  in  fact, 
some  days  I  was  the  only  instructor  present.   Henrik  was  the  Health 
Officer  for  Contra  Costa  County  and  we  asked  him  to  teach  an 
introductory  course  in  epidemiology  which  previously  had  focused  largely 
on  infectious  diseases  and  was  required  for  all  public  health  students. 
Only  epidemiology  majors  and  a  few  physicians  were  exempted  because  we 
assumed  they  already  had  some  background  in  epidemiology.   They  were 
placed  in  a  so-called  "advanced"  course.   Dr.  Blum  was  well  trained  in 
medicine  and  basic  epidemiology  and,  most  importantly,  was  handling 
epidemiological  problems  at  the  community  level  every  day.   We  wanted  to 
bring  that  experience  into  the  classroom  for  students  who  had  a  wide 
range  of  backgrounds  and  interests,  most  of  whom  would  someday  be 
employed  by  health  agencies.   Henrik  welcomed  the  opportunity  to  meet 


VI 


with  students  and  share  his  experiences,  and  he  did  not  limit  the  course 
to  infectious  diseases.   It  was  unfortunate,  in  retrospect,  that  a 
majority  of  the  physicians  and  all  of  the  epidemiology  majors  who  were 
enrolled  in  the  more  advanced  and  theoretical  course  in  epidemiology 
were  unable  to  benefit  from  Henrik's  wisdom. 

During  those  early  years,  Henrik  was  publishing  widely,  not  only 
on  epidemiological  problems  but  also  to  illustrate  how  such  problems 
interfaced  with  community  concerns  and  family  needs  for  health  services. 
Most  local  health  programs  were  focused  on  control  of  communicable 
diseases  and  usually  within  a  fairly  rigid  administrative  framework. 
Henrik  published  on  problems  that  he  had  dealt  with  in  Contra  Costa 
County  such  as  diabetes  detection,  genetic  counseling,  school  lunch 
programs,  mental  health,  vision  screening,  safety  education,  and 
fluoridation  of  water.   In  each  case,  he  focused  on  recognition  of  the 
community's  needs,  its  resources,  and  concerns,  and  whose  participation 
was  essential  to  the  resolution  of  the  problem.   Each  required  a  new 
approach  to  planning  and  organization  to  identify  community  concerns  and 
resources  that  could  resolve  the  issue. 

One  landmark  venture  occurred  in  1966  when  Henrik  and  Dr.  George 
Keranen  developed  a  handbook  entitled  Control  of  Chronic  Diseases  in  Man 
which  was  published  by  the  American  Public  Health  Association.   This  was 
to  be  a  companion  volume  to  Control  of  Communicable  Diseases  in  Man 
which  was  published  by  the  same  association  and  which  sat  on  the  desk  of 
most  public  health  workers.   Unfortunately,  the  chronic  disease  manual 
was  not  reissued  and  expanded  in  future  years  when  such  problems  became 
the  primary  focus  of  most  public  health  programs.   This  visionary 
publication  foresaw  a  need  and  paved  a  pathway  that  public  health  needed 
to  travel. 

At  a  time  in  Henrik's  tenure  as  a  health  officer,  his  staff  became 
unionized  and  he  was  required  to  work  and  bargain  with  the  unions.   His 
approach  to  this  situation  was  to  join  the  union  himself.   You  can 
imagine  the  turmoil  and  consternation  of  the  union  officers  when  they 
found  out  that  the  person  they  had  to  deal  with  concerning  employment  by 
his  agency  was  a  member  of  their  union,  could  attend  their  meetings, 
vote,  et  cetera.   This  innovative  approach  had  a  twist  of  Blum  humor 
behind  it. 

When  Henrik  retired  after  fifteen  years  as  Health  Officer  of 
Contra  Costa  County,  he  had  many  ideas  about  the  future  approaches  to 
public  health  problems.   Although  several  agencies  were  anxious  to 
recruit  him,  when  Dean  Charles  Smith  offered  Henrik  an  appointment  as 
Clinical  Professor  of  Public  Health  at  Berkeley  in  1966,  he  decided  that 
this  could  provide  him  a  base  of  operations,  an  outlet  to  advance  his 
interests  in  health  planning,  and  an  opportunity  to  extend  his  teaching 
in  public  health  administration.   The  original  position  did  not  have  the 
campus  clout  or  financial  security  of  a  tenured  position,  but  when  I 


vii 


became  Dean  in  1968,  I  was  able  to  obtain  a  tenured  appointment  for 
Henrik  as  Professor  of  Community  Health  Planning. 

By  this  time,  Henrik  had  made  it  clear  that  health  planning  had  a 
separate  identity  from  public  health  administration,  and  there  was  an 
opportunity  for  the  Berkeley  School  of  Public  Health  to  become  the 
national,  even  international  leader  in  this  field,  exposing  the 
students,  faculty,  and  other  associates  to  a  new  frontier  in  health. 
Henrik  presented  his  new  approaches  in  the  publication  Public 
Administration.  A  Public  Health  Viewpoint.   He  developed  dialogues  and 
collaborative  arrangements  with  campus  and  outside  professionals  who 
were  leaders  in  aspects  of  planning  from  many  other  fields.   At  this 
time  the  campus  had  entered  a  period  of  strife  and  turmoil  over  the 
Vietnam  War,  free  speech,  minority  needs,  et  cetera.   It  was  a  tough 
time  to  carry  out  the  orderly  planning  of  a  new  curriculum  or  major 
program  which  required  the  joint  effort  of  individuals  who  might  not 
only  have  different  concepts  of  health  planning  but  were  on  opposite 
sides  regarding  current  campus  issues.   As  Dean,  I  was  known  as  a 
conservative  and  Henrik  was  considered  an  activist;  hardly  likely 
"bedmates"  for  a  concerted  activity.   Nonetheless,  we  recognized  from 
the  beginning  that  we  could  both  meet  our  academic  and  social  objectives 
by  joining  forces  to  develop  health  planning  as  a  new  field  of  study.   I 
decided  to  give  him  a  relatively  free  rein  to  see  what  he  could  and 
would  do.   The  proposed  program  stressed  recruitment  of  minority 
students  into  the  school  and  development  of  affiliations  with  other 
academic  departments  on  campus.   It  also  addressed  many  community  issues 
and  needs  concerning  health. 

If  there  was  a  secret  to  the  development  of  this  new  field,  it  was 
first  that  Henrik  had  an  idea  and  he  obtained  a  large  three-year  federal 
grant.   The  grant  assured  financial  support  for  minority  students  to 
fill  nineteen  new  student  admissions  he  had  obtained  from  the  graduate 
division,  allowed  for  the  appointment  of  a  variety  of  new  non-tenured 
faculty  and  staff  from  a  variety  of  fields  and  backgrounds,  and  provided 
resources  to  bring  in  eminent  visiting  speakers  from  many  other  fields. 
It  was  a  great  venture  and  it  succeeded.   In  his  oral  history,  Henrik 
discusses  all  of  this  very  candidly  and  with  no  holds  barred  on 
inclusion  of  controversy. 

One  side  of  Henrik  Blum  that  is  sometimes  hard  to  adjust  to  is  his 
response  when  a  colleague,  student,  or  outsider  asks  for  advice. 
Usually  he  asks  the  person  to  describe  the  problem,  how  he  got  the 
information,  and  how  the  problem  is  being  approached.   If  the  approach 
does  not  show  a  good  comprehension  of  the  problem  at  hand  and  a 
receptivity  to  alternatives,  Henrik  might  tell  them  a  story  about  a 
parallel  experience  and  outcome.   If  the  person  still  doesn't  understand 
what  is  going  on  or  insists  there  are  no  alternatives,  Henrik  may  just 
relate  his  version  of  the  "facts  of  life"  in  no  uncertain  terms.   This 
approach  wakes  up  most  people  and  frequently  solves  their  problems  —  if 


viii 


so,  they  usually  thank  him  and  end  as  good  friends,  and  he  never  forgets 
them.  He  is  one  of  the  few  people  I  know  who  can  give  you  hell  and  then 
have  you  thank  him  for  it. 

Henrik  awakened  a  wide  audience  to  the  breadth  of  community  health 
problems.   Three  of  his  publications  stand  out  as  landmarks  in  the 
emergence  of  health  planning  as  a  field  of  study  and  an  approach  to  the 
health  needs  of  communities.   The  first  is  Public  Administration;  A 
Public  Health  Viewpoint  (1963).   The  second  is  Health  Planning  (1969), 
and  the  third,  Planning  for  Health  (1974),  devoted  621  pages  to  a  broad 
and  in-depth  coverage  of  this  new  field.   It  quickly  became  a  bible  for 
health  planners.   Each  of  these  publications  received  national  and 
international  acclaim,  and  what  had  been  conceived  for  health  planning 
at  a  community  level  in  California  soon  came  to  the  attention  of  the 
World  Health  Organization.   Henrik1 s  account  of  his  national  and 
international  experiences  are  completely  fascinating  as  he  describes  how 
he  functioned  within  each  system.   In  truth  it  was  hard  work  and 
extremely  time-consuming.   Many  of  his  concepts  and  objectives  were  not 
understood  or  were  rejected  by  the  people  assigned  to  carry  them  out, 
and  getting  them  implemented  in  the  real  world  was  a  challenge  which 
required  worldwide  travel.   Marian  accompanied  him  on  all  his  adventures 
and  they  made  many  new  friends  wherever  they  went:  Geneva,  Nepal,  Sri 
Lanka,  Sweden,  Denmark,  Australia,  China,  and  Canada,  to  name  a  few.   A 
senior  faculty  member  of  our  school  tells  me  that  anywhere  he  travels  in 
the  world  today,  he  encounters  followers  of  Henrik  who  are  still  quoting 
his  books  on  health  planning,  or  perhaps  remember  a  visit  he  and  Marian 
made  and  want  to  send  their  thanks  and  regards. 

The  American  Public  Health  Association  paid  its  respect  to  Henrik 
in  1985  when  he  was  presented  its  most  prestigious  award,  the  Sedgwick 
Memorial  Medal.   The  focus  of  that  award  was  to  recognize  the 
contribution  of  his  health  planning  concepts  to  the  field  of  public 
health. 

The  final  chapter  of  Henrik 's  oral  history  might  be  called  an 
encore  before  his  third  retirement.   It  is  devoted  to  his  experiences 
from  1991  to  1994,  when  six  years  after  retiring  as  Emeritus  Professor 
he  was  recalled  to  serve  as  interim  chair  of  the  Health  and  Medical 
Sciences  program  at  Berkeley.   In  this  program,  students  receive  three 
years  of  intensive  training  which  covers  the  first  two  years  of  medical 
school  and  also  requires  completion  of  a  master's  degree  in  Health  and 
Medical  Sciences.   This  was  to  be  a  temporary  one-year  position  while  a 
new  permanent  chair  was  being  selected.   Instead  it  turned  into  a  stormy 
and  difficult  task,  requiring  four  years  of  Henrik 's  time.   The  program 
was  being  assailed  by  several  individuals  and  groups  who  wished  to 
destroy  it,  but  fortunately  since  Henrik  had  been  involved  with  the 
program  since  its  inception,  he  believed  deeply  in  its  objectives.  The 
original  conception  of  such  a  program  had  come  from  meetings  of  a  core 
of  faculty  from  the  School  of  Public  Health  and  a  group  of  practicing 


ix 


physicians  and  hospital  staff  from  the  East  Bay.   Its  roots  went  back  to 
the  1930s  and  earlier  when  students  in  the  University  of  California,  San 
Francisco  medical  school  program  spent  their  first  academic  year  on  the 
Berkeley  campus  taking  basic  science  courses,  which  had  not  yet  been 
developed  in  San  Francisco.   Henrik  had  been  a  student  in  that  program 
in  the  1930s. 

Henrik  dedicated  his  time  as  interim  chair  to  fighting  for 
survival  of  the  program,  recruiting  faculty,  and  broadening  and 
increasing  relationships  with  campus  faculty  in  other  departments.   He 
opened  a  "gateway  to  faculty"  on  the  campus  for  students  to  use  as 
resources  for  their  theses.   He  personally  met  with  as  many  student 
applicants  and  new  admissions  to  the  program  as  possible.   He  had  an 
"open  door"  policy  for  his  office  and  was  available  for  consultation  on 
any  problem.   Rather  than  carrying  out  formal  teaching,  he  attended 
seminars  where  problems  were  presented  by  students  and  discussed.   This 
was  his  ballpark  for  personal  enjoyment.   Within  the  School  of  Public 
Health,  Henrik  is  referred  to  at  times  as  the  "John  Wayne"  of  public 
health  and  medical  education.   He  continues  his  dedication  to  correcting 
the  wrongs  of  society,  fighting  for  the  rights  of  the  downtrodden,  and 
challenging  the  "bad  acts"  of  some  individuals.   If  you  asked  Henrik 
about  this  he  would  probably  smile  and  say,  "And  I  don't  even  own  a 
gun." 

When  Henrik  retired  in  1985  to  become  Emeritus  Professor,  his 
friends  and  associates  paid  their  respects  by  establishing  the  Henrik  L. 
Blum  Award  for  Distinguished  Social  Action.   The  award  is  given  annually 
to  a  graduating  student  of  the  school.   Each  candidate  is  evaluated  for 
his  or  her  public  health  activities  that  symbolize  the  spirit  of  social 
justice  and  democratic  action  which  Dr.  Blum  has  epitomized  and  which  he 
implemented  in  the  minds  and  hearts  of  students,  professors,  staff,  and 
alumni.   The  selection  committee  includes  representatives  of  all  those 
groups.   In  the  past  ten  years,  this  award  has  become  the  most 
prestigious  and  sought-after  recognition  by  graduating  class  members. 
The  recipient  gets  a  standing  ovation  at  commencement  and  a  very  nice 
plaque.   There  is  no  monetary  award  and  none  is  needed.   Recognition  is 
the  award.   The  award  will  long  stand  as  a  reminder  of  Henrik1 s 
standards  and  goals. 

Another  important  current  event  in  Henrik 's  life  occurred  on  May 
22,  1998,  when  he  received  the  Award  for  Excellence  in  Teaching  by  a 
Pre-Clinical  Teaching  Faculty  Member  at  the  commencement  exercises  of 
the  School  of  Medicine  at  UC  San  Francisco.   This  awardee  is  selected  by 
the  students  and  not  by  a  faculty  committee,  and  if  I  know  Henrik,  this 
makes  it  a  very  special  award  for  him.   Although  I  will  be  guilty  of 
plagiarism,  I  would  like  to  repeat  a  statement  made  at  the  presentation 
of  this  most  recent  award:   "Dr.  Blum  has  inspired  generations  of 
medical  students  with  his  personal  example,  innovative  leadership,  and 
commitment  to  promoting  the  health  of  communities.   His  analysis  of 


forces  underlying  the  politics  and  sociology  of  medicine  makes  students 
aware  of  their  own  role  as  physicians  in  society.   When  it  comes  time 
for  students  to  write  their  master's  degree  theses,  he  opens  important 
doors  by  sharing  his  many  academic  and  community  connections.   He 
continues  to  use  his  wealth  of  knowledge  and  experience  in  medicine  and 
public  health  to  guide  and  challenge  students  in  their  exploration  of 
the  fundamental  issues  in  health  care." 

It  has  been  a  privilege  and  valuable  lesson  for  all  of  us  to  be 
associated  with  Dr.  Henrik  Blum  and  we  thank  him  for  sharing  his  history 
with  us . 


Professor  William  C.  Reeves 


School  of  Public  Health 
University  of  California,  Berkeley 
June  1998 


xi 

INTERVIEW  HISTORY- -Henrik  L.  Blum 


Henrik  Blum  was  an  obvious  choice  for  the  Regional  Oral  History 
Office's  public  health  series;  he  has  been  a  giant  in  the  health 
planning  field  for  over  forty  years.   Dr.  Blum,  M.D.  and  M.P.H.,  came  to 
the  University  of  California  faculty  in  1968  with  much  more  than 
theories  on  his  mind.   Unlike  many  of  his  colleagues,  he  had  headed  a 
health  department  (Contra  Costa  County,  1950-1966)  and  before  that 
served  the  U.S.  Public  Health  Service  as  part  of  the  armed  services 
working  on  a  number  of  venereal  disease  assignments  and  research 
projects . 

He  joined  the  UC  faculty  at  the  time  when  the  university  was  in 
great  turmoil  and  quickly  showed  himself  to  be  an  activist.   He  was  one 
of  few  to  insist  on  an  open-door  policy  that  persists  today  well  into 
his  emeritus  years.   Students  remember  his  health  planning  courses,  the 
first  in  the  university's  history,  as  life-changing  experiences  where 
they  learned  the  difference  between  mere  medical  care  that  dealt  with 
disease  and  health  care  that  dealt  with  life. 

Dr.  Blum's  students  always  came  first  and  they  knew  it.   He  could 
always  be  counted  on  to  take  up  the  fight  for  an  individual's  rights  or 
a  student  cause.   When  the  1998  UCSF  medical  school  graduates  wrote  Dr. 
Blum  that  they  intended  to  give  him  a  preclinical  teaching  award  last 
May,  they  cited  his  brilliance  and  excellence,  his  passion  and 
compassion,  his  status  as  "one  of  the  best  role  models  we  have 
encountered  in  all  our  years  at  UCSF." 

Dr.  Blum  came  to  the  oral  history  with  reservations,  wondering  if 
he  would  be  able  or  willing  to  deal  with  the  "down  times."  During  the 
seven  two-hour  sessions  in  his  office  on  the  fifth  floor  of  University 
Hall,  he  proceeded  to  work  through  them  with  utmost  candor;  the  politics 
of  medical  research  and  academia  and  his  involvements  in  those  arenas, 
the  injustices  of  contemporary  society. 

Through  the  years  he  was  always  where  the  action  was:  he 
coauthored  the  original  San  Francisco  Bay  Area  air  pollution  control 
legislation  in  1955,  helped  create  John  F.  Kennedy  University  in  1964, 
established  an  early  and  important  HMO  called  HEALS--now  HealthNet-- 
wrote  signal  texts  in  health  planning,  and  managed  to  consult  for  WHO, 
PAHO,  and  AID  all  over  the  developing  world  —  as  late  as  1986  he  was  a 
Fulbright  teacher  in  Sweden. 

A  highlight  of  the  oral  history  is  his  documentation  of  the  School 
of  Public  Health,  where  he  was  on  the  faculty  for  almost  two  decades. 
As  a  professor  of  community  health  planning  in  1968  he  pioneered  the 
school's  first  health  policy  course  and  became  chairman  of  the  then-new 
program  in  planning  and  policy  and  wrote  the  landmark  textbook  in  the 


Xll 

field,  Planning  for  Health.   Dr.  Blum  arrived  on  the  scene  in  1966,  when 
the  School  of  Public  Health  was  all  but  shut  down  by  student  unrest,  and 
from  the  beginning  of  his  tenure  often  took  unpopular  positions.   With 
no  support  by  fellow  faculty,  for  example,  he  was  able  to  create 
nineteen  slots  for  minority  graduate  students  and  initiate  successful 
recruitment  programs  for  Native  Americans. 

Dean  Patricia  Buffler  suggested  that  the  Regional  Oral  History 
Office  document  Dr.  Blum's  life  and  work  and  has  written  the  preface  to 
the  series;  we  are  indebted  to  her  and  to  Pat  Hosel  for  organizing  the 
fundraising,  and  to  Dr.  William  Reeves  for  his  fine  introduction  to  the 
volume  and  for  serving  on  the  project's  advisory  committee.   Others  on 
the  committee  were  Rosalind  Singer,  Richard  Bailey,  Joan  Bloom,  Patricia 
Buffler,  Lucy  Johns,  Joyce  Lashof,  Mike  McDonald,  George  McKray,  Theresa 
Pipe,  Mary  Pittman-Lindeman,  and  Shoshanna  Sofaer.   Lucy  Johns  also 
provided  important  perspective  as  a  student  of  Dr.  Blum's  in  the  1960s. 

The  seven  interview  sessions,  from  January  to  early  May  of  1997, 
were  held  in  a  relaxed  atmosphere,  with  students  often  greeting  Dr.  Blum 
as  they  passed  the  office,  and  often  went  over  the  scheduled  two  hours. 
There  were  as  many  review  sessions  with  him,  and  after  he  reviewed  the 
text,  Dr.  Blum  wrote  out  in  longhand  substantial  additions;  these  are 
indicated  by  "##"  notations  in  the  text  and  on  the  tape  guide,  and 
sample  edited  and  inserted  pages  appear  after  the  text. 

In  addition,  Dr.  Blum  donated  his  collected  papers  to  The  Bancroft 
Library,  where  they  may  be  viewed  by  researchers. 

Dr.  Blum  is  openly  irreverent  about  many  things  in  the  oral 
history.   The  resulting  document  is  candid—describing  the  downside  of 
local  politics,  academia  and  international  helping  agencies;  on  the 
upside  it  documents  high  incidents  of  morality  of  health  care,  esteemed 
colleagues,  and  the  life  of  an  individual  who  mattered. 

The  Regional  Oral  History  Office  was  established  in  1954  to 
augment  through  tape-recorded  memoirs  the  Library's  materials  on  the 
history  of  California  and  the  West.   Copies  of  all  interviews  are 
available  for  research  use  in  The  Bancroft  Library  and  in  the  UCLA 
Department  of  Special  Collections.   The  office  is  under  the  direction  of 
Willa  K.  Baum,  Division  Head,  and  the  administrative  direction  of 
Charles  B.  Faulhaber,  James  D.  Hart  Director  of  The  Bancroft  Library, 
University  of  California,  Berkeley. 

Caroline  Crawford 

Interviewer /Editor 
September  1998 

Regional  Oral  History  Office 
The  Bancroft  Library 
University  of  California,  Berkeley 


xiii 


Regional  Oral  History  Office  University  of  California 

Room  486  The  Bancroft  Library  Berkeley,  California  94720 

BIOGRAPHICAL  INFORMATION 

(Please  write  clearly.   Use  black  ink.) 

/ 

Your   full  name        /TV/?  ;"  /'  .T        /--  £  S       ~3?  L,  '.  '  ^  _ 
Date  of  birth//  ~//  —  /  C'       _     Birthplace  vy'X?     '!  ~?~  <-?  s^7  '  :  -~~  '•  '  C 
Father's   full  name     /~7  C2  (.  Jl"?        L^>        J  3.      L  VH 


Occupation  (  '  n  }?  ,  ^  L  /  S??  fl  /T 


Mother's   full  name  "7"^  ^  J  ,  ^  £        Jf    l:^"F*A,  IN 

.•i/:  ."?  f^^>  V?  I-*'  /  '^r~  ^ 

Occupation     '   '    '   "  ._!.  _  Birthplace 
//-  ^.^fc-  ,-„-,  ^  C-^ 

Your  spouse  /^/         ^     *^-/s^i  (.  •>"    J  "'  *  -  i 


x^  '  • 
Occupation  ,"fc  ";^_    .•••'••.<•'.  :^.-  ...  _  ^  Birthplace  ?•*  fa  >.?_(_  fi 

'    ' 


Your  children 


Where  did  you  grow  up?  _.<  ^  ./  ,r-  _ ~>   If   -  )  (  j 
Present  community    L  -  7  .  d'    'xV'^'   '  Q~-v 


Education    /'^. ;  x/    .  V'y- 1  >.'-^/V    /A  '"'       /M/7    t>-/'?/d   ^J^       /^m      -;1 


Occupation(s)  j  ^  •_'/•>•  .-'""^'.  .~-^*-  ~.- .- .  -_  >-"   /" 
'""/-/'    .-)''/',  -' 

Areas  of  expertise         .  '/  ;?   J /  fl  J ;  7  /  '^?  / ±>-  T~  f^'1-/  I  £  *•-) >-,  y'/( 


./ 


Other  interests  or  activities    /^^  rfc'\r*7  ^     •'  jf~  l\^ 


?   C 


rK^^>  ^    L\^  '  j/  k^ 

J  V  / 


Organizations    in  which  you   are   active 


-  ?/  ^/  //   ^  /   '^  i=.   ^  /«-, 
'>>  y  V''        ','  '  /.. 


c 


'  -J- 


I   FAMILY  HISTORY,  CHILDHOOD,  AND  EDUCATION:  1915-1934 


[Interview  1:  January  23,  1997) 


Caveats  and  Oral  History 


Crawford:   Let's  begin  at  the  beginning.   Tell  me  as  much  about  your 
family,  and  as  far  back  as  you  can. 

Blum:      I  have  a  couple  of  caveats.   I've  long  since  made  up  my  mind 

that  even  well-kept  notes  are  not  necessarily  trustworthy,  and 
I  never  keep  any  notes.   There's  nothing  I  own  that  I  think  is 
worthwhile  enough  to  keep.   People  send  me  a  letter.   I  get 
through  with  whatever  has  to  be  done,  and  then  I  usually  chuck 
it,  along  with  my  responses. 

So  I  just  don't  have  the  frame  of  mind  that  a  properly  born 
upper-class  person  or  an  obsessive  saver  would  have—that  every 
scrap  of  paper  I  have  either  received  or  filled  out  needs  to  be 
saved  for  posterity.   I've  been  spoiled  by  some  magnificent 
biographies,  such  as  Churchill' s--which  is  really  a  wonderful 
bit  of  writing—but  I  really  don't  trust  the  documentation  he 
provides,  because  I  don't  find  in  it  some  of  the  idiotic  things 
that  he  was  responsible  for,  such  as  Gallipoli. 

Crawford:   You're  talking  about  biographies? 

Blum:      Well,  it  is  an  autobiography,  in  Churchill's  case. 

Crawford:   Are  you  talking  about  the  war  books? 


'##  This  symbol  indicates  that  a  tape  or  tape  segment  has  begun  or 
ended.   A  guide  to  the  tapes  follows  the  transcript. 


Blum:      Yes.   I  mean  his  whole  series;  all  the  volumes.   So,  I'm  quite 
sure  that  diaries  and  autobiographies  aren't  necessarily 
trustworthy.   I  keep  thinking,  Will  I  really  tell  you  some  of 
the  down  times  I've  had? 


Crawford: 
Blum: 

Crawford; 

Blum: 

Crawford; 

Blum: 

Crawford; 
Blum: 


Crawford: 
Blum: 


Won't  you? 

I  don't  know.   I  mean,  I  just  keep  debating, 
kind  of  lousy. 


Some  of  them  are 


Let  me  tell  you  right  at  the  outset  that  you  should  feel 
perfectly  free  to  tell  me  whatever  it  is  about  the  down  times 
you  want  to. 

Some  of  them  don't  speak  well  for  me,  you  see. 
Because  you'll  take  the  whole  text  and  review  it. 

Oh,  yes.   I  realize  that,  but  do  I  or  don't  I  want  to  get  into 
these  things?   Everybody  tends,  I  think,  to  protect  themselves. 

I  understand  you're  a  candid  person. 

Yes.   But  I've  got  to  be  sure  about  this.   So,  one,  I  really 
don't  trust  the  best  tended-to  biographical  material,  and  mine 
is  not  well-tended-to.   Second,  I  don't  trust  anybody's 
integrity  for  sure.   Third,  I  think  each  of  us  smooths  over 
some  things—we'd  like  it  to  be  seen  more  and  more  our  way. 

Fourth,  how  good  is  our  information?   Just  recently  I've 
had  a  chance  to  look  at  the  origins  of  the  UCB  medical  school  — 
this  experimental  medical  school  called  the  Joint  Medical 
Program—which  has  been  such  a  controversial,  interesting 
thing.   Accidentally  I  recently  ran  into  Chancellor  Bowker,  who 
really  carried  the  ball  and  created  it.   He  has  a  totally 
different  memory  of  what  happened  than  I  do.   He  sees  all  the 
problems  that  he  had,  which  I  have  really  ignored.   I  always 
see  the  problems  that  I  had. 

Well,  that's  the  value,  of  course,  of  your  telling  it. 

And  then  a  third  person  coming  through—who  really  wasn't  close 
to  it,  but  who  would  like  to  imagine  he  was  because  he  was  an 
interested  bystander— had  a  totally  different  version  of  it. 
So  here  are  three  versions  of  the  same  thing,  and  I  don't  think 
any  of  them  are  totally  erroneous;  but  the  focus  is  so  off  here 
or  off  there  or  off  elsewhere  that  any  one  of  these  stories  by 
themselves  is  really  only  a  partial  picture  and  therefore  a 


very  different  picture,  emphasizing  different  actions  and 
different  actors. 

Crawford:   Of  course. 

Blum:      The  worst  of  the  caveats  is  simply  that  I  think  that  if  I  had 
done  this  history,  say,  five  years  ago,  before  I  got  involved 
again  with  the  medical  school—the  Joint  Medical  Program—and 
with  Tommy  Kushner--who' s  an  ethicist  in  JMP  who  asked  me  to  do 
some  presentations  on  ethics—that  I  would  not  have  seen  the 
situations  five  years  ago  as  I  see  them  today. 

I'm  talking  about  the  involvement  of,  "Okay,  let's  bring 
out  the  ethical  view,  so  that  students  and  others  can  see  what 
some  often  overlooked  issues  are."  You  suddenly  realize  that 
things  that  are  very  crucial  now  to  an  ethical  understanding  of 
the  situation  didn't  even  exist  at  the  time  of  the  event— at 
least  not  in  my  mind  anyway.   So,  that  by  dint  of  going  back 
over  parts  of  my  career,  I  keep  finding  these  episodes  that  I'm 
not  so  sure  were  terribly  ethical.   Here  I  am  lecturing  to  the 
class  about,  "I  thought  this  was  good  stuff,  and  look  what  I 
did.   Now,  my  god,  I  would  like  to  retreat  from  that.   I  would 
like  to  not  even  have  been  a  participant." 

Crawford:   Well,  I  would  think  you  would  enjoy  that— going  back  and 
bringing  it  all  forward. 

Blum:      I  have  enjoyed  it,  but  I  guess  I'm  saying  that  I  have  reason  to 
doubt  the  real  authenticity,  significance,  of  retrospective 
stuff.   It  wouldn't  make  any  difference  how  well  I  had 
documented  it  then  because  I  would  have  had  a  view  that  I  was 
doing  good  things.   Now  I  look  back  in  horror  and  say,  "That 
was  not  only  not  good,  today  it  would  be  almost  criminal." 

Crawford:   I  wonder,  aren't  you  being  a  little  hard  on  yourself? 


Wartime  Experiment  Using  Human  Guinea  Pigs 


Blum:      Well,  for  Tommy's  seminar,  I  found  the  article  that  part  of  the 
seminar  presentation  was  based  on.   I  tackled  the  issues  of 
coercion  in  my  career,  my  involvement  in  coercive  activities; 
physicians  are  always  in  the  position  of  being  coercive,  you 
know.   But  when  I  was  in  the  service  [stationed  in  Terre  Haute] 
during  World  War  II,  we  experimented  on  human  guinea  pigs. 

Crawford:   Yes,  you  mentioned  this  to  me. 


Blum:      Of  course,  it  wasn't  altogether  horrible.   Nobody  got  hurt. 

Nobody  was  treated  maliciously.   We  thought  that  everybody  was 
treated  rather  nicely--that  is,  the  folks  who  were  being 
experimented  on- -but  notwithstanding,  the  whole  setting  was 
terrible,  in  retrospect. 

I  would  say  that  we  were  kind  of  pleased  with  ourselves, 
doing  that  work.   When  we  handed  out  the  article,1  lo  and 
behold,  it  was  endorsed  by  the  National  Research  Council  and 
the  United  States  Public  Health  Service,  which  also  carried  it 
out . 

Crawford:   It  was  related  to  the  Tuskegee  Study? 

Blum:      No,  no.   It  wasn't  Tuskegee.   Thank  god  I  wasn't  in  that.   Ours 
was  a  smaller  kind  of  a  thing,  but  also  an  experiment  on 
humans.   Somehow,  the  subjects  being  experimented  on  were  not 
really  human  beings.   It  was  just  how  life  was,  you  know. 
True,  but  I  was  four  steps  removed  from  my  boss  who  also  was 
the  boss  of  the  Tuskegee  Study. 

Crawford:   I  think  that's  what  you  told  me. 

Blum:      Yes,  and  the  boss  was  a  lovely  man--I  mean,  a  neat  guy--and  you 
would  never  have  qualms  about  him  marrying  your  daughter.   He 
just  didn't  know  any  better.   Black  people  weren't  people  for 
him.   That  was  how  he  grew  up  in  the  South. 

It  was  disgusting  that  we  missed  every  call  on  it.   I  kept 
squalling  all  the  while  because  I  have  sort  of  an  orderly  mind, 
and  saying,  "Hey,  you  can't  do  science  this  way.   This  is 
garbage,  you  know?"  And  it  was  garbage,  and  nobody  spotted  it. 
It  was  published,  practically  a  book-sized  article  in  a  major 
journal. 

Crawford:   But  don't  we  have  to  feel  good  that  we  have  a  new  perspective 
with  which  we're  looking  backwards  into  history? 

Blum:      Oh,  yes,  we've  come  a  long  way,  but  I  guess  this  is  my  caveat 
about  biography  or  autobiography,  and  that  is:  supposing  I 
hadn't  really  come  back  to  the  medical  school,  and  supposing  I 
hadn't  met  Tommy  and  worked  on  several  ethical  things  with  her? 


'Mahoney,  J.D.,  C.J.  Ven  Slyke,  J.C.  Cutler  and  H.L.  Blum, 

"Experimental  Gonoccocal  Urethritis  in  Human  Volunteers,"  American  Journal 
of  Syphillis,  Gonorrhea,  and  Venereal  Disease.  30:1,  1-39,  January  1946. 


I  was  aware  of  ethics,  but  I  wasn't  that  discerning.   She 
was  the  one  that  got  me  into  giving  a  couple  of  lectures,  and  I 
couldn't  think  of  anything  more  pertinent  than  to  take  a  look 
at  my  own  career.   Wow.   That  was  quite  startling.   That  study 
involving  experiments  on  prisoners  was  my  first  significant 
venture.   Part  of  this  experience  I  had  was  being  coerced  into 
doing  it  wrong.   I  was  in  the  service,  in  uniform,  and  I  knew 
we  were  doing  the  study  badly,  but  I  didn't  object  because  it 
was  done  under  orders  —  shades  of  Nuremberg. 

Crawford:   You  were  aware  that  it  was  being  done  wrong? 

Blum:      Yes.   It  was  so  bad  it  was  gross.   I  kept  complaining  to  my 

immediate  boss,  who  had  one  half  stripe  more  than  I  did.   And 
the  excuse  that  you  use  is,  "Well,  I'm  in  the  service  and  what 
am  I  going  to  do?  Am  I  going  to  fight  it?"   I  did  nothing 
about  it.   Oh,  I  knew  it  was  lousy  work;  and  I  don't  think 
anybody  should  be  exposed  to  an  experiment  that ' s  no  good  and 
can  never  teach  us  anything. 

Crawford:   Did  you  say  it? 

Blum:      Oh,  yes,  and  my  boss  said  to  me--we  had  four  layers  of  bosses 
up  to  the  guy  who  ran  the  Tuskegee  Study,  who  was  an  assistant 
surgeon  general--"Look,  when  any  of  our  bosses  come  through  and 
visits,  just  lay  off  this  stuff."   And  he  said,  "If  the  boss 
says  that  black  is  white,  it's  white.   Get  that  through  your 
head."   This  was  from  my  immediate  superior.   He  too  went  on  to 
be  an  assistant  surgeon  general--!  thought  he  would  at  the 
time . 

Here's  this  whole  Nuremberg  story  of  can  you  hide  behind 
orders,  can  you  say  that  you  had  orders  and  therefore  you  can 
do  this,  that,  and  the  other?   I  never  thought  about  such 
things.   I  knew  that  it  was  lousy  work,  but  I  never  thought 
about  the  coercion.   Of  course,  the  prisoners  on  whom  we  did  it 
were  coerced  in  a  gentle  way—they  were  bribed.   Two  hundred 
dollars  for  an  experiment.   That  was  a  lot  of  money  for  most  of 
those  people.   This  was  in  Terre  Haute,  and  the  bulk  of  the 
prisoners  came  out  of  either  the  ghettos  of  Chicago  or,  more 
likely,  from  the  hills  of  the  Ozarks.   Also,  each  "volunteer" 
got  a  very  positive  letter  to  the  parole  board. 

Crawford:   What  were  the  experiments? 

Blum:      Infecting  them  with  gonorrhea,  which  was  not  a  health  threat  to 
our  subjects  because  we  already  had  penicillin.   We  were  fussy 
about  the  technical  side. 


Crawford:   Infecting  and  then  treating? 

Blum:      And  then  treating,  but  the  issue  was  really  to  develop  a 

prophylactic  for  the  armed  forces  that  troops  could  take  prior 
to  intercourse.   Well,  we  never  could  infect  routinely  enough 
to  ever  trust  any  work  with  prophylaxis.   So  we  never  got  to 
the  prophylaxis  part  of  the  experiment.   We  just  quit  after  a 
year. 

Crawford:   Were  the  prisoners  aware  of  what  was  being  done? 

Blum:      Oh,  yes.   Oh,  yes.   Straight  up.   No  question  about  that. 

Crawford:   It  was  the  money  that  attracted  them? 

Blum:      Yes,  and  a  letter  to  the  parole  board.   We  would  not  call  it 

coercion.   We  didn't  see  it  that  way.   We  thought  it  was  being 
generous;  but  the  truth  of  the  matter  is  it's  coercive  as  hell 
to  a  desperately  poor  prisoner  or  one  who  needs  a  boost  with 
the  parole  board. 

Crawford:   They  knew. 

Blum:      They  knew,  but  it  doesn't  keep  it  from  being  coercive.   In 

other  words,  if  you're  poor  and  somebody  offers  you  something 
to  pull  you  through,  like  real  money—they  couldn't  get 
cigarettes,  or  postage  stamps,  without  some  cash. 

Crawford:   A  kind  of  coercion,  isn't  it? 
Blum:      Well,  it ' s  a  version,  I  think. 
Crawford:   What  do  you  wish  you  had  done? 

Blum:      Well,  I've  since  written  a  position  paper  that  was  used  by  the 
California  Medical  Association--!  was  on  their  committee,  the 
equivalent  of  an  ethics  committee,  from  1983  to  1991.   This 
paper  said  that  prisoners  should  never  be  used  for  experiments 
because  they  are  in  an  unstable  position.   They're  always 
subject  to  fear  or  rewards  that  they  couldn't  get  otherwise; 
and  so  they're  not  necessarily  willing  participants. 

Of  course  there  were  also  very  practical  concerns,  which  I 
learned  by  dint  of  making  rounds,  every  night,  on  my  prisoners. 
And  that  is  they  traded  every  conceivable  pill  they  got  their 
hands  on.   Illicit  drugs  cannot  be  kept  out  of  the 
penitentiary,  not  even  narcotics.   They're  trading  this  all  the 
time  for  a  cigarette,  for  a  this,  for  a  that,  for  a  sexual 
favor,  whatever.   So,  you  don't  even  know  what  else  they're 


taking  or  what  they  are  not  taking  when  you're  doing  an 
experiment  in  a  penitentiary;  i.e.,  you  can't  say  what  is 
really  going  on  with  your  guinea  pig. 

Crawford:   Which  really  invalidates  everything. 

Blum:      It  invalidates  the  whole  business  from  scratch.   Well,  I  don't 
think  we  understood  that  then;  but  when  I  wandered  around  the 
penitentiary  at  night,  making  rounds  and  talking  to  each  of  my 
"good"  patients,  I  discovered  this  reality.   They  leveled  with 
us  because  we  were  not  doctors  working  for  the  penitentiary,  we 
were  outsiders.   So,  the  doctor  gets  a  little  extra  trust. 

Crawford:   Was  there  value  in  what  you  learned? 

Blum:      Well,  some  value  in  what  I  learned,  yes.   So  I  have  no 

hesitation  in  presenting  a  lecture  that  said,  "Not  only  is  this 
research  probably  valueless  because  we  didn't  know  what  we  were 
doing,  we  also  didn't  know  what  the  patient  was  doing."   In 
another  sense  the  patients  are  not  really  free  actors.   They're 
being  bought  and  sold.   Practically  speaking,  it  was 
interesting  that  we  did  have  about  one  in  ten  prisoners  who 
would  neither  take  the  money  nor  the  letter,  who  felt  that  they 
were  expiating  their  crimes  or  sins. 

Crawford:   The  letter? 

Blum:      They  wouldn't  take  the  letter  to  the  parole  board,  and  they 
wouldn't  take  the  money.   They  said,  "I'm  doing  this  because 
I'm  trying  to  do  some  good."  Now,  that's  the  kind  of  person 
that  you  probably  should  be  doing  experiments  on.   If  you're 
going  to  have  human  volunteers  —  if  you  tell  them  not  to  smoke, 
or  not  to  do  this,  or  not  to  do  that,  they  won't  —  and  they  want 
to  do  whatever  the  experiment  calls  for.   They  have  their  own 
reasons  for  wanting  to  do  it  and  helping  society,  as  they  see 
it. 

Crawford:   When  you  talk  to  your  public  health  students  about  this  very 
issue,  what  do  they  say? 

Blum:      It  was  one  of  a  good  many  examples  of  ethical  ignorance—it  was 
so  gross  that  I  don't  think  the  students  got  overly  involved 
with  this  one.   There  were  some  less  clear-cut  versions  of 
unethical  actions  that  they  and  I  thought  were  more 
interesting. 

Crawford:   But  are  they  horrified?  Or  are  they  weighing,  balancing--? 


Blum:      Since  I  was  telling  the  tale,  students  can't  be  too  horrified 
with  me.   Their  attitude  has  more  to  do  with  the  spirit  of  how 
I  presented  the  matter.   Acknowledging  our  ignorance  and 
pointing  out  the  strong  support  we  were  given  by  the  nation's 
top  scientific  bodies  to  do  the  study  effectively  puts  the 
blame  elsewhere,  on  ignorance  and  perhaps  on  the  urgency  of  war 
needs. 

This  study  was  number  one  on  my  list.   It  began  my  career- - 
my  first  work  when  I  became  a  physician,  my  first  real  job. 
Here  I  was,  subject  to  coercion.   I  didn't  dare  talk  back  to  my 
bosses,  and  used  that  as  an  excuse  to  myself. 

We  even  had  another  form  of  coercion  on  that  project  which 
I  thought  was  funny--and  this  was  really  my  own  doing.   My 
boss  —  the  one  who  told  me,  you  know,  "when  the  big  boss  comes 
in,"  and,  "black  is  white  is  white, "--was  a  person  I  totally 
despised.   Everything  about  this  person  ran  contrary  to 
anything  I'd  ever  been  taught  a  decent  human  being  should  be, 
let  alone  a  smart  one,  who  could  even  be  an  M.D. 

There  were  three  of  us  working  under  him:  two  lab  techs, 
who  were  nice  people,  decent  human  beings;  myself;  and  he  was 
our  boss  out  there  on  the  site  in  Terre  Haute.   We  figured  out 
very  soon  that  he  didn't  know  anything.   He  knew  no  medicine, 
he  knew  no  lab  work,  he  knew  nothing.   He  was  a  miserable 
hypocrite.   He  couldn't  even  do  a  physical  exam. 

Crawford:   But  he'd  been  told  by  higher  authorities  what  to  do? 

Blum:      Well,  it  wasn't  that.   He  made  his  way  through  medical  school, 
sounded  good,  knew  all  the  text  book  stuff.   He  couldn't 
examine  a  patient  or  know  what  he  was  feeling,  seeing,  or 
thinking.   Thank  god  he  went  into  administrative  medicine.   But 
coming  into  the  lab  and  hearing  the  lab  techs  say,  [half- 
whispering]  "Come  over  here.   The  boss  says  these  are  red  cells 
and  he's  crazy.   I  mean,  it  just  ain't  so."  But  they  couldn't 
tell  him  any thing- -they  were  too  far  down  the  ranks. 

So  I  went  over  and  looked  at  the  slide,  and  I  could  see 
that  he  was  mislabeling  red  cells  and  calling  them  white  cells. 
Well,  it  wouldn't  change  the  world,  but  just  the  same,  that's 
not  science,  you  know,  and  could  be  unfortunate  if  one  of  our 
clients  had  an  untoward  result. 


So  I  said,  "Boss,  we  need  to  go  through  some  things.  We 
have  to  learn  how  to  agree  with  one  another.  Now,  let  me  cut 
my  finger  and  put  some  blood  in  the  specimen,  here."  Which  I 
did.  "And,  let's  look  at  what  a  red  cell  looks  like  in  a  spun- 


down  urine  specimen."   So,  he  got  to  learn  for  the  first  time 
what  a  red  cell  looked  like. 

Crawford:   That  is  shocking. 

Blum:      Well,  this  is  a  man  who  had  been  out  of  medical  school  for  five 
years.   So  that's  the  kind  of  circumstances  we  worked  under. 
You  don't  have  much  respect  for  a  boss  like  that:  technically 
insolvent,  morally  insolvent.   You  know,  it  was  tough. 

Crawford:   Did  you  do  what  you  could? 

Blum:      Yes,  but  the  experiments  I  couldn't  change.   They  were  all 

worked  out.   First  we  were  going  to  do  this,  then  we  were  going 
to  do  that.   These  were  crazy  experiments.   They  were  stupid, 
they  never  changed  less  than  two  or  three  variables  at  one 
time,  so  we  couldn't  attribute  the  results  to  any  one  thing. 
You  couldn't  learn  anything. 

Crawford:   You  still  read  about  this  today,  don't  you? 

Blum:      Yes.   Well,  today,  I  don't  think  people  are  stupid,  they're 

just  vicious  or  dishonest,  but  then  it  was  stupidity.   Anyhow, 
so  we  used  to  be  absolutely  uncivil  to  the  guy.   We  had  to  eat 
lunch  together  each  day,  and  when  he'd  come  in  the  lab,  we  just 
sort  of  said,  "Get  out.   You're  contaminating  the  atmosphere." 
This  was  our  boss,  you  know.   We  had  it  pretty  well  figured 
out.   We  coerced  him.   We  never  discussed  it  as  such,  but  we 
thought  a  good  administrative  boss  can't  acknowledge  that  he 
has  lousy  assistants.   If  his  superiors  find  that  everybody 
that  works  for  him  is  not  very  good,  there's  something  wrong 
with  the  boss.   He  wouldn't  dare  give  us  all  bad  reports,  and 
he  didn't. 

Crawford:   All  three  hundred  percent? 

Blum:      Right,  right.   So,  we  coerced  him.   That  was  a  different 

version  of  coercion,  but  that  one  situation  had  all  these  three 
levels  of  coercion.   The  nature  of  the  experiments,  the 
prisoners,  and  the  staff  mistreatment  of  the  boss.   I  think 
that  was  kind  of  interesting. 

Crawford:   That's  very  interesting. 

Blum:      If  it  hadn't  been  for  Tommy,  I'd  have  never  spotted  the  gross 
nature  of  the  experience. 

Crawford:   Oh,  I'm  certain  this  worried  you  all  the  time. 


10 


Blum:      I  don't  know.   Three  levels  of  coercion  in  one  show.   We  lived 
with  it  for  almost  a  year,  eleven  months. 

Crawford:   But  doesn't  everybody,  including  students,  have  these  kinds  of 
confrontations  and  conflicts? 

Blum:      Oh,  I'm  sure  many  do.  But  at  the  time,  only  one  version  of  the 
coercion  came  through,  and  that  is  that  we  were  ordered  to  do 
lousy  experiments.   But  I  didn't  rebel  at  being  forced  to  do 
them--I  just  took  it  for  granted  and  accepted  it  as  part  of 
service  life. 

Crawford:   Do  you  think  you  dealt  with  your  superior  in  the  best  way  that 
you  could? 

Blum:  Not  effectively,  never  complained  above  him,  just  like  he  never 
went  above  his  superiors. 

Crawford:   This  was  your  first  such  confrontation? 

Blum:      I  suppose,  yes.   Even  our  boss'  wife  was  aware  of  his  view  of 
getting  ahead.   We  all  lived  near  one  another.   We  all  came 
from  Stapleton,  that's  Staten  Island,  a  big  marine  hospital, 
part  of  the  armed  forces  during  the  war,  and  it  meant  that  in 
those  circumstances,  in  a  pseudo-military  situation,  the  lower 
ranks  have  to  salute  you,  and  you've  got  to  salute  back,  you 
know.   When  somebody  comes  along  that's  got  more  braid  than  you 
do,  you've  got  to  salute  them. 

His  wife  tells  us  how  he's  just  coming  out  of  the  PX 
entrance  with  a  great  big  bag  of  groceries  in  each  arm,  and  up 
drives  an  admiral.   Here  he  is,  what  the  hell  does  he  do  now? 
[laughter]   So  he  drops  both  bags  and  salutes.   She  just  loved 
that  story,  and  I  do,  too,  because  it's  too  close  to  what 
taking  orders  can  become.   [laughter] 

Crawford:   That's  the  way  you  like  to  remember  him? 
Blum:      Yes. 

Crawford:  Well,  I  suspect  your  students  are  very  lucky  to  have  this  story 
presented  to  them  because  it ' s  a  real  story--tangible--it ' s  not 
just  ethics  in  the  mist. 

Blum:      So  we  went  on  in  class  about  ethics,  along  my  career,  and  we 
walked  into  bad  situations.   Very  bad--. 

Crawford:   After  that? 


11 


Blum:      After  that.   Yes. 
Crawford:   In  the  service? 

Blum:      Well,  I  was  out  of  the  service  in  four  years,  and  I  was  treated 
royally  in  the  service.   I  really  can't  complain  about  that;  I 
got  all  good  duty  assignments  even  if  the  workaday  realities 
left  a  bit  to  be  desired.   There  was  one  momentarily  shocking 
episode  to  which  I'll  return  later. 

Crawford:   But  isn't  that  why  every  medical  school  has  an  ethics  section 
now? 

Blum:      About  two-thirds  still  don't;  and  what's  worse,  those  that  do 
usually  talk  about  hooking  up  somebody  to  life  support  or 
unhooking  them,  or  allowing  people  to  make  decisions.   The  bulk 
of  these  people  that  you're  worrying  about  are  going  to  die. 
Some  of  them  wish  you'd  leave  them  alone.   Often  their  families 
are  torturing  them,  and  you're  caught  between  the  family  and 
the  patient,  when  you're  supposed  to  be  worrying  about  the 
patient.   For  sure,  we  need  to  know  these  things,  but  there  is 
so  much  more  to  ethics. 

Crawford:   We're  a  long  way  from  our  humanity--. 

Blum:      A  long  way,  but  I  regard  these  end-of-life  confusions  as 

relative  trivia.   The  real  ethical  issues  are  denying  health 
care  to  people  to  begin  with  —  people  who  had  become  sick.   The 
routine:  "Well,  I'm  sorry.   You're  not  eligible.   Good  bye." 
Their  eyes  may  be  bugging  out  of  their  head,  or  their  legs  and 
feet  are  swollen  and  oozing.   You  look  at  street  people  with 
legs  like  this,  many  of  them  from  standing  in  cold,  heat,  wet, 
and  standing,  standing,  standing.   Or  maybe  they  have  just  a 
little  heart  disease  thrown  in,  and  they  have  no  coverage-- just 
40  million  presons  without  coverage  in  the  U.S.  today.   These 
are  the  real  ethical  issues. 

Crawford:   That  isn't  something  we  used  to  have  to  deal  with  in  great 
numbers . 

Blum:      True,  but  we're  sure  getting  used  to  it.   For  this  ethics 
class,  where  I  was  able  to  produce  two  hours'  worth  of 
material,  I  started  looking  at  different  aspects  of  what  I  had 
done,  and  some  that  I  was  only  modestly  aware  of. 


12 


Parents  and  Childhood  in  Napa 


Crawford; 


Blum: 


Crawford : 
Blum: 


Crawford: 
Blum: 


Crawford: 
Blum: 


Almost  the  first  thing  you  said  to  me  was  that  when  you  were 
very  small,  you  were  drawn  to  public  service—you  knew  that 
there  was  some  kind  of  expectation  and  mandate  for  public 
service  from  your  father  and  mother. 

Well,  to  go  back  to  my  childhood,  neither  of  my  parents  ever 
went  to  school.   They  had  no  formal  education,  and  they  came 
from  tiny  Jewish  communities  somewhere  between  Poland  and 
Russia.   They  were  on  the  border,  and  so  sometimes  they  lived 
in  one  country  and  sometimes  in  the  other  without  having  to 
move. 

Where  did  they  meet,  and  what  were  their  full  names? 

Here  in  San  Francisco.   Pauline  Leplin  and  Haiman  Blum  met 
about  1906  after  the  earthquake  and  fire.   Neither  had  family 
here  initially,  but  ultimately  both  had  brothers  and  sisters 
come  to  San  Francisco,  some  then  leaving  for  New  York,  Los 
Angeles,  Mojave. 

Were  they  farmers  in  Russia? 

Jews  in  Russia  or  Poland  couldn't  be  farmers.   You  couldn't  own 
or  have  any  real  ties  to  the  land.   You  might  sell  produce,  buy 
and  sell,  but  you  couldn't  farm.   It  was  verboten  in  Russia,  as 
it  was  in  most  European  countries.   Neither  of  them  went  to 
religious  or  secular  schools,  so  their  exposure  to  education 
was  really  through  apprenticeship  and  living.   My  mother  was 
apprenticed  as  a  dressmaker  in  a  well-to-do  home.   She  lived 
with  the  family  for  nearly  a  decade.   The  woman  was  a  well- 
known  opera  singer,  and  my  mother  just  made  clothes  for  that 
lady. 

Do  you  remember  the  name  of  the  singer  in  the  family? 


The  opera  singer? 
nothing  to  me. 


No.   I  probably  heard  the  name  but  it  meant 


My  mother  spent  her  life  in  Russia  until  she  was  sixteen, 
making  clothes  on  a  very  elegant  scale.   She  probably  had 
marvelous  teachers,  people  who  could  have  elegant  clothes  made. 
She  was  a  superb  seamstress,  and  when  she  came  to  this  country, 
in  various  hard  times,  she  turned  back  to  that  to  make  a 
living. 

Crawford:   Was  she  elegant?   Did  she  like  to  dress  that  way? 


13 


Blum:      Nope.   It  didn't  mean  a  thing  to  her.   She  did  like  her  clothes 
to  be  just  so.   I  mean,  there's  no  such  thing  as  a  sloppy  hem 
or  a  bad-fitting  garment;  but  as  far  as  elegant,  no;  but  if  you 
made  a  garment,  it  ought  to  be  just  so.   She  made  all  her  own 
clothes,  most  of  mine  when  I  was  small,  even  shirts  when  I  was 
in  high  school. 

Crawford:   High  standards. 

Blum:      Yes.   Nobody  ever  sold  shirts  like  that.   They  were  things  of 
beauty.   Even  I  appreciated  how  elegantly  they  were  made. 
Everything  was  done  just  right.   Well,  by  the  same  token,  she 
learned  about  the  world  of  opera,  music,  literature. 

it  a 

Blum:      She  read  all  the  great  Russian  authors,  certainly,  and  some  of 
the  English  and  French,  too.   So,  it  wasn't  a  boring  existence, 
even  though  she  had  never  gone  to  school,  she'd  learned 
probably  a  hundred  times  as  much  as  she  might  have  in  any 
school  that  she  could  have  gotten  into. 

Crawford:   She  lived  with  this  family? 

Blum:      She  lived  with  them,  yes.   So  it  was  a  pretty  good  background 
without  ever  going  to  school. 

My  father  had  a  really  different  experience.   At  age  five, 
he  was  apprenticed  to  a  woodworker.   The  virtue  of  these 
apprenticeships  is  that  they  feed  you,  and  they  house  you,  and 
they  are  exacting.   He  never  went  to  school,  but  you  know, 
being  in  a  Jewish  community,  they  were  always  exposed  to 
pogroms  and  in  their  teens  faced  the  reality  of  going  into  the 
armed  forces.   Being  in  the  armed  forces  was  not  too  much 
different  than  a  death  sentence.   They'd  probably  find  some  way 
of  getting  rid  of  you,  disposing  of  you,  and  you'd  never  come 
home . 


Crawford: 


Blum: 


The  environment  was  probably  somewhat  radical  in  these 
apprenticeships;  and  the  people  you  apprenticed  for  were 
probably  Jewish,  too,  and  probably  radical.   So  there  was  no 
being  part  of  the  synagogue,  no  studying  the  Torah,  and  all 
that  sort  of  thing. 

When  you  say  radical;  define  that  for  the  purposes  of  the 
history,  if  you  would? 

Politically  and  socially  radical;  i.e.,  being  a  socialist. 


Who  were  their  heroes?  The  heros  were  writers.   After  all, 
Tolstoy  was  a  religious,  peculiar  figure;  but  his  standing  was 
very  much  pro-social  justice,  and  he  felt  that  human  behavior-- 
whether  you  were  rich  or  poor—had  to  be  decent  towards  other 
people  of  any  class.   So  you  start  with  that,  and  then,  of 
course,  you  immediately  get  involved  with  the  sort  of  romantic 
figures  —  the  Victor  Hugos  and  Emile  Zolas--who  were,  all  said 
and  done,  very  pro-social  justice.   This  was  socialism. 

Crawford:   And  they  would  have  been  exposed  to  those  writers--? 

Blum:      Oh  yes.   Yes,  they  had  all  been  translated,  and  they  were 

exposed.   My  father  was  one  of  the  best-read  men  I  ever  knew. 
He  read  everything,  I  mean  everything.   We'd  go  to  the  library, 
well,  he'd  tell  you  about  this,  and  that,  and  the  other  thing. 
He'd  read  it  all. 

Crawford:   He  told  you  about  Zola? 

Blum:      Early.   I  was  probably  five  or  six  when  I  started  reading  that 
kind  of  literature. 

Crawford:   I  remember  you  told  me  that. 

Blum:      By  the  time  I  was  eight  or  nine,  I'd  gone  through  whole 
sections  of  the  library. 

Crawford:   Did  your  father  have  an  extensive  library? 
Blum:      No,  no,  he  used  the  public  libraries. 
Crawford:   He  used  the  library,  yes. 

Blum:      There  were  two  nice  libraries  downtown- -about  three  miles  away. 
Every  Saturday  we  always  had  to  go  to  the  library,  that  was 
part  of  the  routine.   You  just  knew  you  were  going  to  the 
creamery  because  we  had  to  deal  there,  and  you  knew  you  were 
going  to  buy  some  groceries,  and  you  knew  you  were  going  to  the 
library.   That  was  just  par  for  the  course.   You  never  skipped 
that.   Well,  rain  or  shine,  too;  and  originally,  I  guess,  in  a 
horse  and  buggy;  although  I  don't  remember  a  horse  and  buggy. 
I  only  remember  a  car. 

Anyway,  my  father  had  this  tremendous  exposure  to  politics 
and  literature  and  left  Russia  before  he  was  drafted.   All  his 
brothers  came  over,  and  they  brought  the  sisters,  and  so  on. 
It  was  a  large  family,  but  other  than  my  father  they  were  not 
intellectually  or  politically  oriented  at  all. 


15 


Art  meant  little  to  my  father,  whereas  to  my  mother  it  was 
a  big  deal.   Her  treat  in  life  was  to  go  to  the  city  (San 
Francisco).   We  lived  up  in  Napa,  and  we  would  get  on  the  train 
in  Napa,  and  go  to  Vallejo  and  get  on  the  boat,  and  go  to  San 
Francisco.   Then  we'd  spend  a  couple  of  days,  and  a  couple  of 
nights  going  to  operas  or  a  ballet  or  a  concert. 

Crawford:   Oh,  she  brought  you  to  the  theater? 
Blum:      Oh,  yes,  yes. 
Crawford:   Your  father  as  well? 

Blum:      No.   Never,  as  far  as  I  can  recollect.   So  it  was  a  different 
stance.   They  knew  the  same  literature,  they  knew  the  same 
political  logic,  but  he  was  much  more  politically  active,  and 
she  would  say,  "That  was  interesting."   She  didn't  disagree, 
but  that  kind  of  action  wasn't  critical  to  her  life. 

Crawford:   So,  what  he  took  from  the  great  novelists  was  the  political 
ideology. 

Blum:      The  political.   If  you  read  Zola  you  can't  help  but  get  that 
sort  of  thing.   Victor  Hugo  and  Charles  Dickens,  likewise. 
It's  there.   You'd  have  a  hard  time  missing  it.   Well,  I  think 
you'd  have  a  hard  time  missing  it  in  Shakespeare,  too. 

So  this  was  the  kind  of  a  background.   No  siblings.   I  was 
delivered  by  Caesarean,  and  in  those  days  few  of  our  friends 
seemed  to  want  a  second  child,  least  of  all  my  mother.   We 
lived  on  a  farm.   Looking  back  at  that  era  now,  it  was  fine  to 
live  in  the  United  States,  where  I  started.   There's  a  book 
recently  out  called  Comrades  and  Chicken  Ranchers  that  recalled 
many  things  for  me. 


The  Community  in  Petaluma  and  Farming  in  Coombsville 


Crawford:   You  told  me  about  this  book.   Was  it  about  the  Petaluma 
community? 

Blum:       Petaluma  community. 
Crawford:   Talk  about  that,  would  you? 

Blum:      Well,  really,  my  folks  were  kind  of  clever,  as  I  look  back  on 
it,  by  not  going  there,  because  so  much  of  their  lives  in 


16 


Crawford: 


Blum: 


Crawford: 
Blum: 


Crawford: 
Blum: 


Crawford: 
Blum: 
Crawford: 
Blum: 


Petaluma  would  still  be  reliving  what  they  had  escaped  from. 
It  was  typically  Poland,  Russia,  in  terms  of  what  people  argued 
about  and  believed  in. 

In  other  words,  they  wanted  to  stay  away  from  those  populations 
when  they  settled  here? 

I  think  so.   I  think  they  didn't  want  to  lose  them,  but  they 
didn't  want  to  live  in  them  because  everybody  was  very 
argumentative,  and  nobody  was  in  agreement  with  anybody  about 
anything.   I'd  say  about  four  times  a  year,  we  went  to  visit 
families  in  Petaluma.   They  really  only  occasionally  came  to 
visit  us.   This  involved  a  two-  or  three-hour  trip  with  lots  of 
flat  tires. 

They  weren't  relations? 

No  relation.   These  were  people  who  had  many  similar  kinds  of 
experiences  and  feelings  about  things.   Reading  this  book,  I 
can  mostly  understand  now  what  was  going  on.   For  instance, 
there  were  tremendous  battles  between  the  Zionists—they '  re  all 
the  Jewish  people  who  wanted  to  create  a  strong  and  great 
Israel  where  all  Jews  would  be  equal  and  would  have  reasonable 
opportunity—and  the  anti-Zionists,  which  my  parents  were,  who 
said  "that's  no  solution  to  anything.   So,  it's  great  for  the 
Jews,  but  how  about  creating  a  world  where  it  would  be  great 
for  all  peoples?   Jews  aren't  that  important."  That  was  a 
miserable  minority  view  because  "Jews  are  the  chosen  people"  in 
the  eyes  of  most  Jews.   Both  my  parents  were  thrilled  with  the 
idea  of  being  in  the  U.S.A.  and  working  for  the  betterment  of 
peoples  here  and  everywhere  in  the  world. 


A  very  strong  view,  yes. 


They 


My  folks  were  saying,  "What's  so  chosen  about  the  Jews? 
must  be  pretty  corny  if  all  they  want  is  something  for 
themselves."  Well,  you  see,  we  didn't  have  to  get  into  that 
battle  but  maybe  a  couple  times  a  year,  and  we  picked  families 
to  visit  who  felt  more  or  less  the  way  we  did  about  things. 

To  be  your  friends? 

Yes. 

Were  there  organizations? 

Yes,  there  were  many,  some  of  which  cut  across  these  Zionist 
divisions.   There  were  many  Jewish  families  whose  goal  in  life 
was  to  make  it  big.   Zionism  was  not  the  issue  for  them.   These 


17 


people  were  further  subdivided  into  those  who  wanted  their 
children  to  be  professionals  and  others  who  wanted  them  to 
become  successful  businessmen.   Even  further  apart  were  those 
like  my  parents.   The  things  that  really  counted  in  my 
childhood  were  from  my  mother's  standpoint  being  an  artist  of 
some  sort,  or  an  intellectual  or  writer. 

For  my  parents,  making  it  wasn't  what  living  was  all  about. 
It  was  about  making  a  living,  all  right—you  shouldn't  be 
starving,  but  you  should  be  worrying  about  a  decent  society. 
So  any  of  those  acquaintances  who  became  significant  business 
successes  slowly  were  dropped  out  of  sight,  we  just  didn't 
associate  with  people  like  that. 

Crawford:  Looked  down  upon? 

Blum:  Yes.   We  just  didn't  associate  with  them. 

Crawford:  Did  she  write  or  keep  a  diary? 

Blum:  No,  no. 

Crawford:  She  was  busy. 

Blum:      Yes.   We  were  on  a  farm,  and  she  did  more  work  than  my  father 
did.   That's  an  old  Jewish  custom,  of  course.   The  men  prayed 
and  studied  the  Torah  (my  father  never  really  did),  and  the 
women  made  a  livelihood  for  the  family,  took  care  of  the  home, 
the  husband,  children,  and  everything  else.   So  it  wasn't  easy, 
but  it  wasn't  something  she  thought  was  remarkable.   One 
worked,  that's  all;  and  if  she  could  do  more,  she  did  more. 
Now,  of  course,  for  many  years  off  and  on,  when  things  were 
tough,  my  father,  who  was  an  excellent  cabinetmaker,  went  to 
work  full-time,  earned  good  wages,  and  my  mother  did  most  of 
the  work  on  the  farm.   Heavy  duty  tasks  fell  to  my  father  at 
the  end  of  the  day  and  on  weekends. 

Crawford:   What  was  the  balance? 

Blum:      Well,  fifty-fifty.   About  half  the  years  were  bad  so  he  had  to 
work  away  from  home.   About  the  half  the  years  we  could  see  a 
possibility  of  earning  a  normal  living  off  the  farm,  so  we  all 
worked  on  the  farm.   [laughter] 

Crawford:   But  you  always  had  good  food,  you  said? 

Blum:      Oh,  always,  because  he  was  a  disciple  of  educated  farm 

management  people.   He  doted  on  UC  Davis,  which  was  the  aggie 
school. 


18 


Crawford:   Were  there  resources  there  for  him? 

Blum:      Well,  yes,  because  they  had  farm  extension  services  —  they  still 
have.   So,  if  you're  in  grape  growing  country,  there's  an 
extension  agent  there  who  really  knows  about  grapes.   If  you're 
in  chicken  country,  he  knows  about  chickens;  and  if  it's 
turkeys,  it's  turkeys.   We  always  turned  to  those  people  for 
advice.   They've  got  booklets,  and  they  come  out,  and  study 
your  situation  and  advise  you.   If  you  have  a  sick  plant  or 
animal,  they'll  take  it  and  get  a  diagnosis  for  you.   It's  a 
really  remarkable  relationship—the  old  land  grant  colleges  to 
the  farmers— that  was  the  tie.   That  was  meant  to  be  the  tie, 
politically. 

So,  at  least  once  a  year,  we  would  go  to  UC  Davis.   That 
was  Aggie  Day.   It  was  open  house  for  actual  and  potential 
clients.   People  gathered  from  all  over  California  up  there  at 
Davis.   We  always  went,  and  it  was  kind  of  a  holiday.   You  got 
to  see  all  the  wonderful  cattle  and  sheep  and  goats  and 
chickens  and  orchards,  and  all  kinds  of  new  gadgetry  and 
methods.   But  in  between  time,  you  didn't  have  to  go  there. 
The  extension  people  would  get  this  stuff  for  you.   In  my 
childhood— 1915  to  early  twenties--!  think,  looking  back  on  it, 
they  also  had  an  intellectual  plague  —  they  kept  teaching  self- 
sufficiency.   That  meant  diversification. 

Crawford:   A  plague? 

Blum:       I  call  it  an  intellectual  plague  because  they  were  certainly 

not  concerned  with  the  farmer's  survival  in  a  practical  sense. 
We  had  forty-two  acres,  and  we  had  twenty  kinds  of  food  crops 
on  it.   Well,  you  can't  make  a  living  from  anything  with  twenty 
tiny  different  crops. 

Crawford:   But  they  proposed  that? 

Blum:      They  said,  "Well,  you  should  raise  these  kinds  of  apples:  this 
is  for  early,  this  is  the  middle,  this  is  the  late,  this  will 
store."  We  had  ten,  fifteen  kinds  of  pears;  apples— at  least  a 
dozen  kinds;  cherries— a  half  a  dozen.   It's  insanity.   I  mean, 
you  can't  sell  them.   You've  got  more  than  you  can  eat,  but  you 
can't  sell  them  because  you  don't  have  enough  of  any  one  kind. 
We  concentrated  on  giving  things  away. 

Crawford:   So,  with  a  single  crop,  you  would  have  been  able  to  do  better? 

Blum:      On  occasion,  with  a  single  or  a  few  crops,  you  at  least  had 

volume  enough  to  attract  somebody  to  buy  it,  but  you  couldn't 
sell  ten  boxes  of  this  or  five  boxes  of  that.   For  a  brief 


19 


period  of  time,  Safeway  in  its  early  days  would  buy  such  small 
quantities. 

Crawford:   About  when  did  Safeway  come? 

Blum:      It's  got  to  be  in  the  twenties.   If  it  wasn't  Safeway,  there 
were  some  other  outfits:  Scaggs,  Purity,  and  Piggly  Wiggly. 

Crawford:   And  they  could  buy  small  amounts? 

Blum:      They  could,  but  it  wasn't  long-term  good  business  for  them; 
they  were  just  wasting  their  time. 

Crawford:   Not  the  way  they  market? 

Blum:      Not  the  way  to  do  business.   If  they  bought  an  item  for  one 

store,  then  this  store  has  to  get  rid  of  it,  but  they  couldn't 
mass  advertise  it.   Folks  have  to  come  in  and  see  it  because 
they  don't  hear  about  it  and  can't  plan  on  having  it.   So  the 
farmers  who  diversified  were  practicing  a  kind  of  economic 
suicide.   But  we  did  eat  well. 

Crawford:   Did  your  mother  can  like  crazy? 

Blum:      Oh,  yes.   The  house  had  a  full  basement  because  that  was  the 
hatchery  —  ultimately  the  main  activity  was  raising  chickens, 
and  often  turkeys.   But  much  of  that  basement  was  filled  with 
canned  fruits  and  vegetables  of  our  own  production.   Poultry 
meat  we  always  had  available. 

Crawford:   That  was  in  the  days  before  freezing,  I  suppose,  of  meat? 

Blum:      Yes.   I  should  say  that  the  hatchery  was  seasonal,  but  a  major 
undertaking.   We  had  two,  three,  four,  five  thousand  chickens 
and  we  hatched  them  all.   So  Mother  had  a  short  eighteen-hour 
day  which  included  turning  each  egg  twice  a  day  while  it  was 
hatching;  and  when  the  chickens  began  laying,  before  shipping, 
each  egg  had  to  be  candled--put  it  in  front  of  a  light  to  see 
that  it  was  free  from  blood  spots.   Today  chicken  farms  have 
millions  of  birds,  but  then  all  the  work  was  done  by  hand-- 
every  bit  of  it.   We  even  mixed  up  the  mash  they  lived  on  by 
hand,  distributed  it  to  each  chicken  house,  likewise  cut  the 
greens  and  distributed  them,  and  collected  the  eggs  twice  a 
day. 

Crawford:   You  did  a  lot  of  that? 

Blum:      I  did  some  of  it.   There  were  times  when  I  did,  especially  when 
school  was  out,  although  I'd  more  likely  be  involved  with  the 


20 


crops  than  with  the  chickens, 
see . 


It  went  on  simultaneously,  you 


Crawford:   Now,  was  this  diversification  true  of  the  farmers  you  knew  in 
Petaluma,  as  well? 

Blum:      No,  in  Petaluma  I  don't  think  there  was  a  fruit  tree  in  the 

lot.   They  went  into  chickens  pretty  exclusively.   And  when  we 
were  raising  three  or  four  thousand,  some  of  them  had  thirty 
and  forty  thousand,  primarily  white  leghorns.   These  were  for 
eggs  and,  also,  the  young  male  ones  for  meat.   So,  in  any  case, 
they  would  have  great  years  and  bad  years,  but  as  this  book  on 
Petaluma  brought  out,  there  were  a  few  years  in  which  many 
poultry  raisers  got  liquidated.   When  you  get  liquidated  with 
only  one  crop,  that's  all  you've  got  to  eat.   They  really  got 
liquidated. 

Crawford:   Who  published  Comrades  and  Chicken  Ranchers? 
Blum:      Kenneth  L.  Kann,  Cornell  University  Press,  1993. 

But  that  kind  of  a  life  on  the  small  farms  meant  that 
farmers  lived  at  most  a  few  miles  apart—but  at  least  a  block 
apart  —  from  most  people.   It  meant  you  went  to  a  country 
school.   I  went  to  Harmony  Country  School.   Children  came  in 
from  about  a  mile  radius.   It  was  a  wonderful  community  in  an 
international  sense.   There  were  a  few  families  of  English 
background,  several  Irish,  several  Scotch,  there  were  Swiss  and 
Romany  Swiss  gypsies.   There  were  Italians  from  several 
regions,  there  were  French,  Alsatians,  Australians,  there  were 
several  kinds  of  Germans --Bavarian  and  otherwise.   There  were 
Polish,  American  Indian,  Jews  from  Russia,  Portuguese,  Danes, 
but  no  Hispanic  or  black  families. 

Crawford:   Was  there  wine  activity  already? 

Blum:      No,  not  a  great  deal  because  it  was  Prohibition  most  of  that 
time.   Some  people  were  gambling,  as  we  did,  that  it  would  be 
gone,  and  so  started  planting  vineyards;  but  the  wine  business 
was  dead.   And  we  lived  in  a  part  of  Napa  that  is  not  ideal  for 
grapes  to  this  day. 

Crawford:   Where  was  the  farm? 

Blum:      In  a  place  called  Coombsville,  it's  just  due  east  of  Napa,  and 
the  road  doesn't  quite  go  anywhere.   It's  not  the  road  to 
Sacramento,  that's  a  little  different;  but  it  goes  up  into  some 
hills.   Vallejo  City  used  to  have  its  water  supply  there.   It 
moved  the  water  from  up  there  in  Napa  down  to  Vallejo. 


21 


Crawford : 
Blum: 
Crawford : 
Blum: 


Crawford : 
Blum: 


My  father  just  had  a  wild  old  time.   I'd  get  in  the  car 
with  him—usually  my  mother  was  busy  —  and  we'd  go  visit  the 
Pole,  and  we'd  hear  about  things.   He  had  a  radio  set  about 
four  feet  long  with  a  hand  full  of  dials.   He  got  news  from  all 
over  the  world.   Next  door  to  him  there  was  an  Englishwoman  who 
wrote  for  various  papers  and  magazines. 

The  English  lady,  who'd  been  a  writer,  was  kind  of  fun.  She 
was  a  very  vivacious  character.   She  had  a  prune  orchard  and 
didn't  know  a  damn  thing  about  it;  and  my  father  would  always 
tell  her  what  to  do  next.   We  also  had  a  Scotch  man  up  the 
street,  and  he  grew  apples  about  eight  inches  in  diameter;  they 
were  just  indecent  to  us  ordinary  farmers.   He'd  remove  many  of 
the  apples  on  the  tree  and  leave  a  dozen,  and  he'd  sell  the 
dozen  for  more  money  than  anybody  could  make  by  the  usual 
methods  of  raising  apples. 

Well,  I'm  thinking  of  the  kinds  of  people  that  we  had.   All 
of  them  sort  of  spoke  English;  it  was  our  common  language,  and 
we  all  got  along.   Some  of  them  were  in  the  same  mess  we  were 
with  diversification,  and  some  were  not.   Some  were  poor- 
nobody  was  really  wealthy.   My  father  was  a  great  organizer,  so 
he  helped  organize  the  school  district,  and  this  and  that.   The 
school  was  already  well-established  when  I  got  there;  but  they 
finally  combined  with  another  district  and  got  a  bigger  school 
and  more  teachers  and  buses  after  I  had  graduated. 

Good  school? 

Good  enough,  yes. 

And  certainly  international. 

Oh,  yes.   That  was  good.   Our  Native  Americans  were  showpiece 
people.   They  were  the  favorite  family  around—mother ,  father, 
two  grown  sons.   Everybody  went  to  visit  and  look  at  them 
because  they  were  so  beautiful. 

They  weren't  ostracized? 

Oh,  no.   No,  they  were  elites.   They  were  carpenters  or 
something--well-skilled.   They  were  Carlisle  Indians  and  their 
name  was  Carlisle.   They'd  been  well-educated,  probably  spoke 
English  better  than  most  of  the  others  in  Coombsville.   They 
were  also  very  friendly  people. 


Crawford:   Kept  their  traditions? 


22 


Blum:      Not  really.   No,  they  were  Americanized.   They  were  just 

handsome,  tall,  well  muscled,  slightly  reddish  smooth  skin, 
somewhat  acquiline  features,  gorgeous. 

Crawford:   Were  there  churches  for  all  the  different  faiths? 

Blum:      Well,  the  churches  were  not  out  there.   This  community  was  out 
in  the  sticks,  but  it  went  the  three  miles  downtown  to  the 
churches.   I  didn't  even  know  there  were  Jews  downtown.   On 
thinking  about  it,  it  turned  out  there  were.   The  druggist  was 
there—we  always  patronized  that  druggist—well,  it  was  the 
main  one;  and  the  hardware  store;  and  one  of  the  clothing 
stores  which  we  couldn't  patronize—it  was  too  elegant;  and  one 
housewares  family;  and  there  was  a  cider  factory.   These  were 
all  Jewish  families.   Oh,  and  there  was  a  huge  tannery,  and 
it's  still  in  business  in  the  Bay  Area.   Those  were  Spanish- 
Jewish  people,  and  I  never  dreamt  they  were  Jewish:  they  were 
so  fancy  and  they  were  among  the  elite  of  local  society. 
Living  in  the  country,  I  never  had  any  idea  there  were  other 
Jews  around. 

Crawford:   Really?  Didn't  talk  about  it? 

Blum:      No. 

Crawford:   Your  father  wasn't  a  religious  practitioner,  was  he? 

Blum:      Oh,  lord  no;  and  I  don't  know  if  these  other  people  were  or 
not.   There  was  certainly  no  synagogue.   We  had  one  Jewish 
family  neighbor  and  I  believe  my  father  had  talked  them  into 
moving  out  there.   They  brought  some  uncles  and  brothers  along 
with  them,  who  were  as  highly  skilled  as  he  was.   They  were 
machinists  and  machine  operators.   They  had  to  commute  to  San 
Francisco,  though,  where  their  work  was.   So  they  finally  gave 
up  after  a  few  years,  as  their  farm  was  even  more  useless  than 
ours  for  making  a  living. 

That  was  the  only  Jewish  family  that  I  really  knew,  and 
they  lived  near  us  for  three  or  four  years.   They  had  a  boy 
older  than  me.   This  was  part  of  my  Jewish  experience.   It  was 
interesting  because  they  weren't  the  least  bit  concerned  with 
the  arts  or  ethical  and  political  issues.   They  kind  of  went 
their  way.   They  were  the  making-it  crowd,  although  at  one  time 
they  had  been  more  political.   That  kid  and  I  both  hit  grammar 
school  at  the  same  time,  and  he  was  a  great  success.   Everybody 
loved  him.   He  was  a  good  athlete,  small,  but  could  do 
any thing- -tough,  courageous,  very,  very  gregarious,  the  perfect 
ail-American  kid.   And  here's  me  a  year  behind  him,  playing  the 


23 


piano,  stuffed  shirt,  couldn't  mix  with  the  kids.   I  was  a  year 
or  two  younger. 

Crawford:   That  was  a  kind  of  an  intellectual  disparity? 

Blum:      Yes,  and  more  than  that.   I  was  always  smaller  wherever  I  was 
because  I  was  younger.   So  I  started  retreating,  and  then  I 
commenced  to  treat  myself  as  a  superior.   That's  part  of  it, 
I'm  sure:  the  defense—because  I  couldn't  play  football  and 
couldn't  run  fast  enough,  or  hit  a  baseball- -was  to  look  down 
on  the  "clods"  who  could. 

Crawford:   But  you  played  the  piano. 

Blum:  Yes.  And  that's  a  big  deal.  You  earn  a  lot  of  cordial  hatred, 
and  you  in  turn  despise  these  people  who  think  you  are  a  sissy, 
and  you  look  down  on  them  as  poor  low-brows  who  play  football. 

Crawford:   Did  you  exaggerate  that  or  did  they  react  that  way  to  you? 

Blum:      Oh,  yes,  because  on  the  way  home,  I  used  to  get  beaten  up,  and 
they'd  call  me  interesting  names  and  so  on.   It  wasn't  too  evil 
and  it  wasn't  too  vicious,  but  it  was  clear  that  I  was  a  Jew, 
yet  this  other  Jewish  kid  never  got  this.   He  wasn't  a 
ringleader  in  their  activities  when  they  were  pestering  me,  but 
he  was  totally  acceptable  to  the  other  kids  and  I  wasn't. 

Crawford:   And  that  was  on  the  basis  of  his  being  an  athlete,  I  suppose. 

Blum:      Well,  no.   It  was  on  the  basis  of  being  a  real  all-around  guy, 
you  see.   He  wasn't  a  nuisance.   I  mean,  he  was  one  of  the 
folks,  and  I  was  not.   One  could  say  that  this  was 
discrimination  because  I  was  a  Jew,  but  the  truth  of  the  matter 
is  that  I  wasn't  one  of  them  and  they  just  found  that  I  was 
Jewish,  and  that  was  handy- -something  to  torture  you  with. 

Crawford:   You  were  different. 


Schooling 


Blum:      Yes,  so  they  made  an  issue  of  my  being  Jewish;  but,  in  fact,  as 
I  look  back  I'm  sure  that  had  nothing  to  do  with  it  because 
there  was  our  Jewish  neighbor  having  a  great  time. 

Another  awful  thing  happened.   I  skipped  the  second  grade, 
and  this  helped  set  the  stage.   This  is  a  little  country  school 


with  about  forty  kids--and  about  that  time  they  divided  it  into 

two  rooms  with  twenty  each:  the  first  four  and  the  highest  four 

grades.   So,  I'm  the  guy  that  skipped,  and  they  had  never  had 
that,  apparently. 

Shortly  thereafter,  the  state  examiner  came  by.   That  was  a 
big  event,  the  state  examiner.   Here  I  was  in  the  third  grade 
down  here,  and  there  was  the  five  to  eight  grade  room.   They 
took  me  into  that  room,  and  had  me  read  for  the  state  examiner. 

Crawford:   Into  the  fifth  grade? 

Blum:      Well,  in  front  of  grades  five,  six,  seven,  and  eight.   I'm 

reading  for  the  whole  school  so  the  examiner  will  be  impressed 
with  how  well  we  read. 

Crawford:   So  you  were  definitely  singled  out. 

Blum:      Oh,  boy. 

Crawford:   Which  is  never  good? 

Blum:      Yes.   [laughter]   Particularly  when  it's  clear  that  you  were 

chosen  as  the  one  that  can  impress  the  state  examiner,  and  the 
rest  of  the  people  are  sort  of --if  you  can  just  keep  quiet, 
we'll  do  better.   [laughs] 

Crawford:   That's  teacher's  pet,  magnified  by  thousands. 

Blum:  Oh,  yes.  So  I  can  still  see  it;  and  I  enjoyed  that,  you  see. 
I  mean,  I  wasn't  unaware  of  what  was  going  on.  I  still  get  a 
kick  out  of  it. 

Crawford:   You  liked  being  different? 

Blum:       I  didn't  mind  it  for  a  positive  cause,  i.e.,  showing  that  you 
can  read.   Subsequently,  I  had  a  lot  of  anti-Semitic  remarks 
made,  and  was  beaten  up  on  the  way  home  from  school  and  this 
thing  and  that  thing;  but  I  don't  think  it  was  really  anti- 
Semitic  at  all--. 

Crawford:   It  was  just  being  picked  on. 

Blum:      Yes,  but  it  would  happen  to  a  Jew,  though,  because  that's 
exactly  their  tradition  of  being  into  cultural  things, 
intellectual  things,  reading—you  know,  the  whole  shmeer. 

Crawford:   Would  there  have  been  only  two  Jewish  families  in  this  school? 


25 


Blum:      Yes,  and  the  other  family  was  soon  gone. 
Crawford:   The  school  was  out  of  town. 

Blum:      Out  of  town  in  Hannony--a  little  country  district.   There  were 
only  forty  students,  even  at  its  maximum.   The  school's  still 
there.   The  building's  kind  of  cute.   Somebody  cleaned  it  up, 
and  it's  a  home  now. 

I  went  to  the  town  school  at  about  the  seventh  grade  or 
eighth  grade.   You  weren't  supposed  to,  but  my  folks  figured 
that  I  wasn't  getting  everything  that  I  should  get  in  Harmony. 
So  I  switched  to  the  town  school.   Unfortunately  I  had  also 
skipped  the  sixth  grade,  so  I  couldn't  parse  sentences  when  I 
got  to  town.   So  this  is  the  bright  kid  coming  to  town,  and  I 
missed  the  world  of  parsing.   I  still  don't  know  what  it  is. 
It  just  scared  the  hell  out  of  me  to  be  such  a  dumbbell  in 
front  of  the  whole  town  class. 

Crawford:   Nobody  parses  anymore. 

Blum:      Well,  I  knew  I  wasn't  missing  too  much  because  it  was  clear 

that  I  knew  more  literature  than  the  teacher.   I  knew  more  math 
than  the  teacher.   This  was  the  good  town  school.   It  was  clear 
I  was  in  great  shape,  except  not  in  phys .  ed.,  and  not  in  the 
carpentry  shop.   I  could  no  more  do  what  my  father  did  than 
fly,  perhaps  I  was  blocking  because  I  couldn't  stand  him. 

Crawford:   And  your  father  was  so  skilled. 

Blum:      Well,  first,  I  wasn't  allowed  to  mess  around  at  home.   That 
was,  "Well,  you  won't  do  it  right."   So  I  worked  out  an 
arrangement  when  I  was  probably  eight  or  nine.   The  steps  were 
falling  off  our  house,  which  was  up  above  this  big  basement. 
My  father  said  he'd  fix  them.   So  he  bought  the  boards  and  they 
lay  around  for  two  or  three  years.   Stair  boards  are  expensive 
and  nicely-shaped,  rounded  edges,  and  so  on;  but  they  don't  go 
on  the  stairs  by  themselves.   They  just  sat.   The  railing 
started  to  fall  off. 

I  cut  all  the  stairs  to  size,  cut  all  the  risers.   And  I 
did  all  that  very  secretively,  and  filched  the  nails,  and 
tucked  away  the  tools;  and  then  one  day  when  I  knew  my  father 
was  going  to  be  gone  for  several  hours,  (I  didn' t  go  downtown 
on  that  Saturday)  I  stayed  home,  and  I  put  those  stairs  in. 
And  we  had  some  bitter  times  over  that  because  this  was  a 
"lousy"  job.   It  really  wasn't  done  very  well,  but  the  stairs 
were  solid  and  safe  and  I  felt  good  every  time  I  looked  at 
them. 


26 


Crawford:   It  was  done. 

Blum:      Done,  you  know.   So,  to  this  day,  I  have  strong  feelings 
against  perfection. 

Crawford:   It's  intimidating,  isn't  it? 

Blum:      Not  only  that,  it's  a  way  to  see  that  nothing  happens.   I  can't 
say  that  my  father  didn't  want  anything  to  happen,  but  he 
certainly  didn't  make  the  stairs  happen  while  we  waited  for  the 
perfect  job. 

Crawford:   Well,  he  wasn't  afraid  that  he  wouldn't  do  a  perfect  job,  was 
he? 

Blum:       Oh,  no.   All  the  while  he  wasn't  doing  it,  he  was  out 

rebuilding  somebody's  house  or  barn  for  free.   This  used  to 
gall  my  mother  and  me.   He'd  go  over  there,  and  he'd  set  in 
cabinets  for  a  neighbor;  and,  it  was  nice--I  don't  begrudge  him 
the  fun  of  doing  it- -but  he  could  have  done  our  stairs  in  the 
course  of  one  of  those  jobs. 

Crawford:   Never  did  appreciate  your  stairs?  He  never  did? 

Blum:      He  never  took  them  out.   Then,  when  I  put  in  the  second  set, 
the  back  stairs,  well,  we  didn't  hear  about  that.   [laughs] 

Crawford:   Good  for  you. 

Blum:      We  had  a  long—half-mile  long- -driveway  through  our  farm,  and 
it  was  just  a  big  mud  hole.   We  had  a  little  stream  that  would 
run  through  in  the  wintertime,  and  would  wash  up  a  lot  of  nice 
gravel.   So  I  had  a  kid's  wagon,  and  I'd  load  up  the  gravel  and 
haul  it  into  all  the  mud  holes;  and,  you  know,  after  a  couple 
of  years,  we  had  a  pretty  good  driveway.   He  didn't  object  to 
that. 

Then,  once,  when  we  switched  over  to  raising  turkeys,  we 
had  to  build  a  huge  chicken  house  that  was  two  hundred  twenty 
feet  long.   That's  a  lot  of  chicken  house.   It  was  about 
twenty-four  feet  wide.   It  was  also  built  for  chickens,  and 
there  was  a  roost--a  platform  and  the  roost  on  it--and  I  did 
the  whole  thing. 

My  father  and  some  neighbors  poured  the  concrete  floor. 
That  was  a  big  job,  and  I  helped.   Then,  when  it  came  to 
putting  up  the  wood,  I  did  it  all.   That  was  quite  a  job.   It 
took  me  the  whole  summer.   That  was  kind  of  fun.   So,  again, 
perfection  was  not  my  style,  but  we  got  it  done. 


27 


Crawford:   That's  right.   Was  he  very  exacting? 

Blum:       I  think  he  gave  up  on  me.   For  himself,  yes.   I  mean,  even  if 
he  was  just  patching  a  barn  or  a  door  latch  or  something: 
everything  just  so. 

Crawford:   What  were  your  parents'  expectations  for  you? 

Blum:      Oh,  from  my  mother  it  was  very  clear.   I  should  amount  to 
something—be  a  writer,  an  artist. 


Blum: 


Crawford: 
Blum: 

Crawford: 
Blum: 


I  should  also  be  capable  of  making  a  good  living,  but  that 
wasn't  regarded  too  highly.   One  could  be  a  doctor,  one  could 
be  an  engineer  as  second  best.   It  turned  out  that  my  talents 
were  not  as  a  musician,  and  not  as  a  writer--. 


But  she  would  have  loved  that? 

Yes.   That  would  have  been  good, 
ranch. 


We  even  had  a  piano  on  the 


Well,  we'll  get  to  that.   We  want  to  explore  that,  too. 

So  they  settled  for  my  doing  engineering,  creating  structures, 
you  see.   Not  the  kind  of  thing  you  think  of  today,  more  the 
heroic  stuff:  the  bridges,  the  big  building.   So  that's  what  I 
settled  for,  and,  since  my  math  was  adequate,  and  since 
drawing- -which  was  not  my  forte--didn' t  seem  to  be  imperative 
for  engineers,  although  many  of  them  are  good  at  it;  why,  we 
all  settled  for  engineering.   My  father  really  had  very  little 
to  say  about  all  that.   In  fact,  at  the  time  I  went  to  college, 
I  think  he  would  have  liked  me  to  have  stayed  on  the  farm  and 
just  done  the  work.   Except  there  was  no  farm  because  it  was 
the  Depression  and  the  farm  went  for  the  mortgage. 


High  School  Egalitarianism  and  Elitism 


Blum:      Something  more  about  my  childhood,  before  we  get  to  UC.   The 

truth  of  the  matter  is  that  one  part  of  me  is  totally  missing; 
and  that  is  that  I  was  brought  up,  as  I  said,  never  to  fight. 
A  physical  encounter  was  absolutely  for  animals.   It  was  just 
inconceivable  that  you  fought  people  with  your  fists  or  any 
other  way.   So  there  was  very  little  fighting  in  my  life,  and 
certainly  very  little  fighting  back;  and  other  than  the  gentle 


28 


Crawford: 

Blum: 

Crawford: 

Blum: 


persecutions  I  described,  which  weren't  all  that  bad,  I  was 
never  in  a  fight.   In  the  country  situation,  we  were  spread  out 
enough  so  you  didn't  have  to  fight.   It  wasn't  like  being  in  a 
ghetto  or  in  the  big  city,  where  you  had  to  fight  for 
everything,  I  gather,  at  least  nowadays. 

So,  when  I  got  to  high  school  at  age  eleven,  I  started  gym. 
The  people  I  was  tossed  in  with  were  from  mostly  fourteen  to 
eighteen.  At  eleven  years,  you're  not  too  well-formed;  I 
wasn't.   I  had  a  hell  of  a  time  with  gym,  and  got  to  dread  the 
gymnasium,  and  the  tumbling—all  that  stuff.   I  was  just  scared 
to  death  of  it  and  stayed  away  from  it  as  much  as  possible; 
and,  at  the  same  time,  I  was  thriving  on  the  intellectual  side 
in  high  school. 

The  intellectual  side,  as  I  indicated  before,  is  heavily 
weighted  towards  fairness  and  justice,  and  romantic  ideals 
about  just  people,  fair  people,  the  whole  bit.   So  finding  that 
that  wasn't  typical  of  my  classmates—who  really  hadn't  read 
much  of  anything,  thought  about  anything,  didn't  care  about 
politics  as  I  did,  which  was  in  our  house  all  the  time— I 
developed  this  interesting  dichotomy  of  being  very  much  an 
egalitarian  in  spirit,  and  very  much  an  elitist  in  reality. 
This  really  hung  on  for  all  my  life;  and  I  was  well  aware  of  it 
when  I  got  to  the  university.   It's  kind  of  an  oddball 
combination,  supposedly;  but  not  oddball  at  all,  it  turns  out, 
it's  very  common.   One  of  the  things  that  you  do  is  to  put 
aside  the  physical  people:  the  athletes  and  the  folks  who 
really  do  all  the  wonderful  things  in  the  way  of  dance  and  this 
and  that,  unless  it's  on  stage.   And  by  being  a  clod,  in  fact, 
you  sort  of  protect  yourself  by  being  an  elitist.   So  you're 
above  all  this  physical  expertise,  and  that  isolates  you  even 
further. 

Yes.   I  can  see  it. 


It 


just  really  has  plagued  me  all  my  life. 


Weren't  there  students  like  you? 

Very  few.   I  had  very  few  friends.   The  handful  of  friends  I 
had  were  all  oddball.   One  of  the  close  ones  just  died  the 
other  day.   He  came  to  see  me,  thought  he  was  dying,  and 
thought  we  might  not  see  each  other  again,  and  so  he  set  up  a 
visit.  He's  a  little  older  than  I.  He  was  a  huge  Irish  kid, 
Catholic,  who  lived  right  on  the  banks  of  the  Napa  River  where 
it  always  flooded.   Their  house  was  on  stilts.   They  were  poor, 
desperately  poor.   His  mother  was  a  washerwoman- -a  woman  over 
from  Ireland— a  wonderful  lady,  who  had  horrible  hypertension. 


29 


I  just  can't  believe  what  her  blood  pressure  must  have  been 
before  she  died  of  a  stroke. 

Crawford:   How  did  that  manifest  itself? 

Blum:      She  was  red  in  the  face,  and  she  was  very  volatile.   You  just 
knew  she  was  going  to  burst  one  of  these  days  in  front  of  you. 

Crawford:   And  she  was  not  treated  for  hypertension? 


Blum: 

Crawford: 

Blum: 


Crawford: 
Blum: 

Crawford: 
Blum: 
Crawford: 
Blum: 


Oh,  there  was  no  treatment.   There  was  no  treatment  for  high 
blood  pressure  in  the  good  old  days. 

They  wouldn't  have  detected  that,  then? 

They  could  detect  it  but  couldn't  control  it  —  remember  FDR.   So 
what's  the  use  of  bothering?   They  wouldn't  have  done  anything 
but  talk  about  it.   I  met  Bill  in  high  school.   It  was  also  the 
very  first  year  we  had  a  great  crop  of  apricots;  I  knew 
something  about  him  from  school.   He  was  a  nice  person,  a  giant 
of  a  fellow. 

I  asked  him  if  he  cared  to  come  out  and  work  in  the  fruit. 
Well,  it  turned  out  he  was  desperate  for  a  job.   I  would  say 
that  he  worked  for  us  for  at  least  four  years,  off  and  on,  on 
every  job  there  was.   My  father  thought  he  was  fabulous,  and  he 
thought  my  father  was  fabulous.   Well,  I  never  got  along  with 
my  father.   But  we  didn't  get  into  that.   Bill  and  I  were  very 
close  friends,  and  he  was  my  big,  physical  buddy. 

And  what  a  rich  friendship,  that  you  kept  it  for  decades. 


From  '27  to 
didn't  come 


'96.   That's  almost  seventy  years, 
out  with  Bill,  thank  goodness. 


My  eliteness 


What  was  Bill's  last  name? 

Mills. 

Bill  Mills.   And  what  happened  to  him? 

Well,  very  nice  things.   We  graduated  together,  and  when  I  came 
to  Cal,  he  went  to  Richmond  to  a  job  in  the  Ford  assembly 
plant.   I  think  they  were  just  opening  it  up.   There,  he  met  a 
local  girl,  got  married.   Her  family  finally  cleared  out, 
saying,  "We  don't  want  to  work  on  assembly  lines,"  and  they  all 
went  up  to  Grass  Valley,  across  the  highway  from  Auburn.   There 
are  two  little  towns  there,  and  one  of  them,  Grass  Valley,  is 
the  home  of  the  Empire  Gold  Mine,  an  exciting  landmark  that  you 


30 


can  visit  now.   It's  a  state  park.   This  is  the  place 
associated  with  Filoli  on  the  peninsula,  and  plays  a  part  in 
Wallace  Stegner's  Angle  of  Repose.   They  settled  up  there  with 
two  kids,  and  he  bought  a  big  piece  of  land  for  near  nothing. 
He  was  in  the  television  repair  and  sales  business.   When  the 
land  suddenly  skyrocketed  in  value  he  took  up  contracting,  and, 
every  year,  built  a  house.   He  became  a  prosperous  builder, 
built  quality  homes. 


We'd  meet  at  class  reunions, 
there. 


He'd  drive  the  biggest  car 


Crawford:   This  would  be  Napa  High  School  reunions? 
Blum:      Napa  High  School. 
Crawford:   So  you  went  to  those? 

Blum:      A  couple  of  them.   It  was  really  nice  to  see  this  kid  making 
it. 

Crawford:   He  did  very  well. 

Blum:      Yes,  and  not  the  least  bit  boastful  or  a  show-off  or  anything-- 
except  for  the  car.   He  loved  cars.   He  always  did  when  he  was 
a  kid  and  never  had  any.   Didn't  have  a  car  until  halfway 
through  high  school.   Then  it  was  stolen  by  the  dealer,  who'd 
never  filed  the  license  plates  with  the  state.   The  company- 
General  Motors  —  repossessed  the  car,  and  all  this  money  that  he 
put  into  it  was  gone  because  the  dealer  absconded  with  it. 

Crawford:   He  couldn't  trace  it? 

Blum:      Not  that,  the  dealer  went  to  Brazil  with  everybody's  money-- 
from  hundreds  of  cars.   That's  a  lot  of  bucks. 

Over  these  years,  I  was  sort  of  picked  up  at  high  school  by 
another  group  of  people,  also  Catholic.   The  Smiths,  just 
lovely,  lovely  people.   They  had  just  moved  to  Napa.   There 
were  three  kids  in  the  family:  one  in  my  class,  an  older  sister 
a  year  ahead,  and  a  younger  boy  a  couple  years  behind.   The  one 
in  my  class  was  a  personality  kid--as  different  from  me  as  you 
could  get-- just  full  of  jokes,  a  character.   He's  still  up 
there.   We  went  through  school  together;  and,  gathered  around 
him  was  this  group  of  kids  that  we  associated  with.   These  two 
sets  of  associates  were  very  separate  groups:  Bill  Mills  and  I 
in  one  setting,  these  other  people  and  I  in  another.   I  was 
very  close  to  those  people  too.   The  Smiths  practically  adopted 
me  when  my  family  split  up--I  was  the  only  child.   My  mother 


31 


had  to  have  a  hysterectomy  for  fibroids,  and  we  had  no  money. 
A  wonderful  Napa  doctor  who  did  surgery  at  St.  Mary's  in  San 
Francisco  was  our  usual  doctor.   He  said,  "I'm  not  going  to  do 
it,  I'm  going  to  have  a  better  qualified  doctor  do  it."  He 
paid  for  the  hospital  and  the  surgeon,  and  took  the  whole  thing 
on  his  back. 

Crawford:   This  private  doctor? 

Blum:      Yes,  and  so  my  mother  went  to  work  for  him  in  his  home.   He  had 
little  kids.   She  worked  there  for  quite  a  few  years.   So  the 
Smith  family,  knowing  that  I  was  left  on  the  farm  with  my 
father—we  didn't  really  fight;  I  was  going  my  way  and  he  was 
going  his  way—they  sort  of  practically  adopted  me.   It's 
interesting.   These  people  who  were  so  different,  and  accepted 
everything,  and  God's  authority,  all  but  this  one  son  who  was 
my  classmate.   He  was  really  a  rebellious  rascal,  in  a  quiet 
way.   I  went  to  Cal.   He  went  to  Stanford  and  became  an 
engineer,  the  kind  that  explores  for  oil,  and  did  so  all  over 
the  world—an  interesting  career.   The  father  was  a  magnificent 
stone  mason,  and  ran  the  local  business  of  making  headstones. 
Mrs.  Smith  was  a  tough,  small  woman,  but  very  kindly.   There  I 
was  surrounded  with  different  kinds  of  people— really  not  my 
kind  of  people  at  all— but  those  are  the  people  I  got  along 
with  so  well. 


Crawford: 


In  the  year  when  I  dropped  out  of  college--!  did  that  after 
the  first  half  a  year,  when  engineering  had  fallen  apart  and  I 
was  sitting  there  with  no  money,  having  spent  all  my  savings--! 
went  back  and  worked  for  him  part  of  the  time,  setting 
headstones.   That's  a  kind  of  brute  labor.   The  rest  of  my 
time,  I  worked  on  a  prune  dehydrator,  and  picked  fruit. 

By  the  time  I  got  through  high  school,  I  started  to  grow  a 
bit.   When  I  got  there,  I  was  fifteen  and  probably  5 '10"  or 
something.   You  asked  me,  was  I  tall.   Well,  at  the  first  class 
reunion,  which  was  fifty  years  after  we  graduated  from  high 
school,  when  my  wife  and  I  came  in  the  door,  many  people  were 
already  seated— we  had  driven  up  primarily  to  see  Bill  Mills 
and  his  wife.   We  came  on  in,  and  my  wife  kept  hearing,  "that's 
little  Henry."   [laughter) 

But  back  to  being  an  elitist.  A  message  that  I  grew  up 
with  was,  "if  other  people  think  it's  good,  you'd  better  watch 
it,  it's  probably  crap."  That  certainly  set  the  stage  for 
being  isolated. 

Well,  that's  what  you  had  said.   Your  mother  had  taken  you  to 
cultural  things  in  San  Francisco,  and  I'm  sure  many  of  those 


32 


children  had  not  been  exposed  that  way. 
of  a  common  grounding,  was  it? 


It  wasn't  really  much 


Blum:      No,  and  you  get  the  habit  of  looking  down  your  nose  out  of 

self-protection  because  you  can't  compete  for  athletics,  for 
games.   Nobody  wants  you  on  their  team  when  it  comes  to  a  real 
game.   So  in  high  school,  what  did  I  do?   Joined  the  debating 
team. 

Crawford:   Talk  about  that. 

Blum:      Well,  it  was  interesting  because  the  subject  is  picked  by 
somebody  else.   By  happenstance,  your  team  will  get  the 
positive  or  the  negative  side  of  an  issue,  and  that's  what  you 
do.   You  don't  come  into  it  taking  the  side  you  want,  you  have 
to  perform  on  a  clean  table.   You  have  a  couple  of  weeks  to 
prepare  for  a  debate.   We  would  debate  with  other  high  schools. 
I  was  relatively  good  at  it,  and  just  a  wee  bit  nasty,  just  to 
keep  the  folks  in  the  audience  happy.   [laugher]   Well,  it's 
not  quite  nastiness,  but  it's  kind  of  making  fun  of  the  other 
guy's  arguments  or  logic,  undermining  their  credibility. 

Crawford:   You  don't  mean  demeaning? 

Blum:      Well,  as  I  look  back  on  it,  I  think  that  some  of  the  comments 

were  just  at  that  edge  of  taking  a  popular  side  of  an  issue  and 
then  making  a  joke  of  it.   I  remember  one  of  the  debates  was 
about  the  chain  store  business:  the  chain  store  versus  the  mom 
and  pop.   Well,  my  girlfriend  in  high  school  was  the  daughter 
of  a  family  with  a  mom  and  pop  grocery.   Her  folks  were  very 
pleasant,  but  kind  of  austere.   They  were  really  quite 
religious,  but  not  Catholics  —  Protestants  of  some  sort.   I 
remember  a  crack  that  I  made  about  the  issue,  that  if  we  were 
not  going  to  allow  the  chain  stores  to  come  in—then  we  were 
going  to  be  stuck  with  these  poor  little  places  where  they 
weren't  too  keen  on  hand  washing  and  sanitation.   I  knew  that 
household  all  too  well.   [laughs] 

Crawford:   You  really  knew  what  you  were  talking  about. 

Blum:      But  one  is  not  supposed  to  say  that  kind  of  a  thing.   One  is 

supposed  to  talk  about  the  economic  aspects.   And  I  suspect  my 
girl  was  sitting  there  and  laughing.   She  came  to  Cal  a  year 
after  1  did.   The  first  book  she  wrote  was  reasonably 
successful.   She  dumped  me  for  a  very  handsome,  lovely,  big, 
powerful  Irish  guy. 

Crawford:   On  the  basis  of  that  debate? 


33 


Blum: 


Crawford: 
Blum: 
Crawford: 
Blum: 

Crawford: 

Blum: 

Crawford : 
Blum: 


Crawford: 
Blum: 
Crawford; 
Blum: 


Oh,  no,  for  some  reason,  she  decided  we  were  a  very  poor  match; 
and  we  were.   I  was  not  very  keen  about  having  a  lot  of  kids. 
She  was  going  to  raise  as  many  as  possible.   Intellectually,  we 
had  a  lot  of  things  in  common,  but  in  terms  of  practical 
living,  no.   I  was  sort  of  on  her  trail  for  several  years.   In 
that  first  book  of  hers,  the  heroine  was  her,  the  hero  was  part 
me,  part  her  husband,  but  they  surely  had  lots  of  kids.  They 
were  living  up  in  New  Monterey,  you  know--Steinbeck  country, 
Tortilla  Flats.   I  had  a  chance  to  visit  with  them  when  I  was 
stationed  at  Fort  Ord  in  1941. 

He  was  an  artist  and  she  was  a  writer? 

Yes.   He  was  really  handsome--a  powerful  fellow. 

Would  their  names  be  known? 

I  think  so:  Jean  Ariss.   She  didn't  write  under  her  maiden 
name,  she  took  her  husband's. 


Well,  let  me  ask  you  before  we  go  there, 
high  school? 


Were  there  mentors  in 


No.   Some  teachers  did  take  hold,  but  I  don't  remember  a  person 
in  that  role,  although  my  English  teacher  and  my  chemistry 
teacher  were  both  impressive,  and  not  just  to  me. 

So  these  very  strong  f riendships--a  couple  of  them—were  really 
what  you  held  onto? 

Interestingly  enough,  another  one  was  a  kid  whose  father  was  an 
administrator  at  Napa  State  Hospital.   We  were  quite  close  and 
had  a  lot  of  interests  in  common.   He  too  was  not  an  athletic 
person.   He  was  more  like  me  than  almost  anybody  else  I  knew  in 
high  school.   He  went  to  Stanford.   I  met  him  thirty  years 
later,  here  on  the  campus.   He  was  visiting  people  that  he 
knew,  who  were  also  friends  of  mine.   I  hadn't  realized  that  I 
was  going  to  meet  him,  but  did.   It  was  fun.   He  was  a  very 
sweet  person.   He's  since  passed  away,  as  I've  learned. 

What  was  his  name? 

Jeffries. 

So  several  people  went  on  to  Stanford  from  your  high  school? 

It  was  a  class  that  really  blossomed.   The  high  school  did  not 
have  a  strong  tradition  of  sending  people  to  college,  and  all 
of  a  sudden  with  the  arrival  of  a  new  superintendent,  there 


were  college  students  bursting  out  all  over,  and  particularly 
into  chemistry—there  were  a  lot  of  people  here  in  chemistry 
from  that  high  school. 

Crawford:   Was  he  a  chemist? 

Blum:      No,  but  he  brought  in  good  teachers;  and  one  of  them,  a  Mr. 

Buchanan,  was  a  wonderful  teacher;  and  everybody  got  enthused 
about  chemistry.   We'd  never  heard  of  it  before,  but  suddenly 
everybody  took  chemistry  because  it  was  such  fun.   He  was  good, 
technically.   I  was  here  at  a  dinner  some  years  ago  at  the 
chancellor's  house,  and  a  man  who  was  once  head  of  the 
chemistry  department  here  and  then  became  a  chancellor  at 
another  one  of  the  UC  campuses  was  at  the  table  where  I  was. 
He  asked  me  where  I  went  to  high  school,"  and  I  said,  "Napa." 
He  said,  "Didn't  you  have  a  wonderful  chemistry  teacher?"   This 
was  a  professor  in  chemistry,  here—world-famous  too.   I  said, 
"Yes,  we  did."  He  said,  "I  remember  the  man.   He  sent  us 
wonderful  students."  You  kind  of  wonder,  where  were  the 
students  before  and  after  this  teacher  who  induced  so  many 
students  to  become  chemists. 

Crawford:   That's  extraordinary. 

Blum:      Yes.   And  here  is  the  former  dean  of  the  school  of  chemistry, 
aware  that  there  was  a  great  teacher  out  there  because  there 
had  been  so  many  of  his  students  here.   There  were  Phi  Betas, 
and  more  Phi  Betas;  and  one  UCB  valedictorian.   All  kinds  of 
good  students  from  such  heretofore  barren  Napa  soil. 

Crawford:   All  who  came  from  a  small  class  of  sixty  or  so. 

Blum:      Yes,  tiny,  and  for  several  years  in  a  row.   Even  schools  take 

on  characteristics;  but  you  wonder:  is  it  the  teachers  or  is  it 
the  school,  or  demographic  changes? 

Crawford:   Were  you  close  to  this  teacher? 

Blum:      Not  personally  close,  but  as  a  student,  I  just  loved  the  class. 
I  said  if  I  didn't  become  an  engineer,  I'd  be  a  chemist. 

Crawford:   What  else  do  you  remember  studying,  and  what  made  an 
impression? 

Blum:  Well,  a  lot  of  English,  a  lot  of  literature.  That's  where  I 
goofed  because  if  I  hadn't  done  all  that,  I  could  have  taken 
typing.  So  I'm  still  crippled  for  lack  of  knowing  how  to  type. 

Crawford:   One  of  the  most  important  courses. 


35 


Blum:       I  know  it,  and  nobody  ever  said,  "Are  you  going  to  college?" 
They  took  for  granted  I  was  going  to  college.   I  was  not 
encouraged  to  waste  time  on  "commercial"  courses.   Stupid. 
Although  I  also  I  never  took  Latin  out  of  pig-headedness ,  so  I 
might  not  have  taken  typing  even  if  encouraged  to  do  so,  being 
an  elitist. 

Crawford:   Latin  was  offered? 

Blum:      Greek  and  Latin.   But  I  was  emancipated  from  what  was 

apparently  current.   I  did  study  French  for  three  or  four 
years,  in  that  way  picking  up  a  lot  of  language  background. 


The  Depression  Years 


Crawford:   Talk  about  the  Depression. 

Blum:      I  came  to  UC  Berkeley  in  '31,  and  the  farm  went  under  in  about 
'32.   It  was  really  already  under  in  '31.   There  was  a  mortgage 
of  five  or  six  thousand  dollars.   The  Petaluma  book  makes  it 
clear  how  it  occurred.   Every  year  you  borrowed  the  money  for 
the  eggs,  the  chicks,  the  feed,  the  whatever  you  bought.   Then, 
after  so  many  months,  you'd  suddenly  have  this  flood  of 
chickens  or  eggs  or  whatever,  and  you'd  pay  the  debt  off. 

You  lived  that  way  all  your  life.   When  they  had  a  couple 
of  bad  years  in  Petaluma,  and  people  couldn't  buy  the  poultry, 
the  people  suddenly  had  these  unpayable  mortgages.   So  farms 
all  over  just  folded.   And  ours  did,  similarly.   But,  in  any 
case,  there  was  nothing  to  stay  home  for,  either.   I  mean,  you 
could  talk  about  taking  care  of  the  farm,  it  was  pointless. 
Who  was  going  to  turn  on  the  pumps  to  irrigate  the  trees  or  the 
vineyard  when  the  crops  couldn't  be  sold?  Who  was  going  to 
raise  and  feed  chickens  when  you  couldn't  sell  them? 

Crawford:   Nobody  had  the  wherewithal,  did  they? 

Blum:      Nobody  had  the  wherewithal,  and  you  couldn't  get  rid  of 

produce.   We  hit  the  Depression  when  we  were  into  turkeys.   We 
were  selling  them,  then,  at  cost.   We  would  get--on  the  hoof 
with  all  the  feathers  and  every thing- -maybe  thirty-two  cents  a 
pound.   You  could  survive.   It  wouldn't  lose  money.   Once  in  a 
long  while--come  Christmas  or  Thanksgiving- -you'd  get  forty- 
eight  cents.   Incidentally,  it's  of  interest  to  note  that  those 
prices  are  not  too  different  from  the  prices  today. 


36 


Crawford:   You're  kidding? 

Blum:      Oh,  no.   If  you  buy  turkeys  around  Christmas  time  or 

Thanksgiving,  you'll  find  the  price  is  often  not  too  different 
from  what  I  was  used  to  in  the  twenties. 

Crawford:   So  that  was  a  good  deal  of  money,  then? 

Blum:      Yes,  also  evidence  that  farmers  produce  food  at  much  lower  cost 
today. 

Crawford:   When  you  were  getting  it? 

Blum:      Yes.   When  we  were  getting  it.   The  one  market  we  had  for  heavy 
chickens  was  Chinatown,  San  Francisco,  because  they  wanted  big, 
beautiful,  live  birds.   You  know  the  current  squabble  in  San 
Francisco  about  live  birds?  Well,  the  Chinese  were  the  only 
people  who  were  fussy  enough  to  insist  on  having  a  good, 
healthy,  live  bird  when  they  bought  it. 

Crawford:   Everybody  else  wanted  them  dressed? 

Blum:      Others  didn't  give  a  damn  where  they'd  been  or  how  they  got 

there.   The  Chinese  were  the  only  fussy  customers  we  had.   When 
we  were  in  the  heavy  chicken  business,  much  of  it  went  to 
Chinatown  for  premium  prices.   They  paid  more,  they  were 
willing  to,  they  wanted  good  birds. 

Crawford:   For  restaurants? 

Blum:      Not  really.   They  were  in  the  windows,  and  the  people  would 
come  in  and  pick  one  out  for  their  own  family. 

Crawford:   Did  they  come  get  them  at  the  farm? 

Blum:      We  delivered  them  live  to  Chinatown.   That  was  the  nicest  kind 
of  arrangement  we  ever  had:  with  the  Chinese  merchants  who  sold 
live  poultry.   People  came  and  picked  them  out.   We  had 
beautiful  birds,  and  people  were  willing  to  pay  extra.   It's 
kind  of  funny  because  now  live  birds  have  become  an  issue,  an 
animal  cruelty  issue. 

In  any  event,  the  farm  went  under,  and  so  there  wasn't  any 
use  in  talking  about  me  staying  on  the  farm;  besides,  I  had  no 
intention  of  staying  on  the  farm.   I  couldn't  conceive  of  a 
more  idiotic  way  of  making  a  living.   You  never  knew  whether 
you  were  going  to  have  a  living  or  not.   We  did  because  my 
father  always  went  to  work  as  a  cabinet  worker,  and  was  so  good 


37 


at  it  that  he  could  always  get  a  job.   When  the  farm  died,  why 
stay? 

Crawford:   Did  he  love  fanning? 

Blum:      Not  really.   No,  the  point  to  the  farming,  and  the  point  to  the 
Petaluma  situation  was  very  straightforward.   It  was  kind  of 
socio-political.   Where  could  you  go  and  be  your  own  boss  —  you 
come  from  a  city  life;  and  with  really  no  great  money  to 
invest—but  you  can  always  borrow  on  the  farm,  and  have  a 
mortgage  going;  have  no  bosses  —  that  was  critical- 
Crawford:   Independent? 

Blum:       Independent.   And  you  didn't  have  to  have  much  help.   You 

didn't  have  to  boss  anybody  else.   That  was  part  of  the  credo, 
be  on  your  own. 

Crawford:   That's  why  not  to  choose  a  city  existence? 

Blum:  Yes.  So  the  whole  Petaluma  scene,  in  that  sense,  was  familiar, 
acceptable,  because  they  mostly  felt  the  same  way.  That  was  an 
odd  kind  of  socialism. 

Crawford:   Were  they  politically  organized  in  any  way? 

Blum:      My  father  spent  his  time  organizing  farmers,  much  of  his  spare 
time.   He  helped  the  poultry  producers  of  California  found 
Nulaid  Eggs.   He  got  people  to  sign  up.   It  was  a  co-op.   He 
helped  organize  the  prune  growers- -the  Sunsweet  people,  who've 
become  something  other  than  a  lovely  farm-centered  operation- 
he  helped  found  that  crowd  because  we  had  prunes,  you  see,  and 
dried  fruit.   So  he  was  into  all  these  organizing  things--. 

Crawford:   He  was  organizing? 

Blum:  Yes,  and  it  was  always  at  the  co-op  level,  on  his  own  time  and 
out  of  his  own  pocket.  It  wasn't  to  set  up  a  big  industry,  it 
was  to  allow  the  little  guy  to  come  out  even. 

Crawford:   What  did  he  do  when  the  farm  closed,  then? 

Blum:      Since  the  people  who  foreclosed  it  couldn't  do  anything  with 
it,  they  said,  "Well,  stay  there.   Watch  over  it."   So  he 
raised  a  little  of  this,  and  raised  a  little  of  that  for  a  year 
or  two.   Then  he  just  cleared  out.   My  mother  and  he  had 
separated,  maybe  four  years  before  the  ranch  went  under  they 
had  separated.   I  started  here,  and  she  came  and  joined  me 
after  a  year  or  so. 


38 


Crawford:   You  had  told  me  that  she  influenced  your  attitudes? 

Blum:      Well,  she  was  an  elitist,  in  a  sense.   There's  no  question 
about  that.   I  mean,  she  expected  the  most  from  me,  she 
expected  the  most  from  everybody,  didn't  see  my  father 
producing  the  most  of  anything,  and  was  very  disgusted  with 
him. 

Crawford:   So,  the  political  organizing  was  not  her  interest. 

Blum:      She  didn't  object  to  it,  she  approved  of  it  in  principle,  but 
it  was  nothing  that  she  did.   She  took  a  back  seat  in  all  of 
that.   Her  goals  were—she  wanted  to  see  social  justice,  she 
was  willing  to  spend- -we  spent  money  whenever  we  had  it  on  all 
sorts  of  good  causes.   She  wanted  a  good  world;  but,  for  me, 
she  wasn't  interested  in  organizing.   She  wanted  me  to  be 
something  worthwhile,  and  it  was  really  cultural,  you  know.   So 
I  came  here  when  I  was  fifteen  and  started  Cal--. 

I  didn't  really  see  any  justification  in  my  going  back  to 
the  farm.   My  father  wasn't  holding  anything  together.   He 
wasn't  supporting  my  mother  or  me  or  anybody  else.   It  was  just 
himself,  it  got  to  be  that.   He  wasn't  one  of  those  that  was  on 
the  bum,  he  actually  worked  in  orchards.   He  knew  how  to  do  it, 
but  that  wasn't  his  forte.   He  worked  as  a  millwright  in  the 
timber  business.   He  worked  in  shipyards,  doing  ship-building 
kind  of  jobs.   There  weren't  many  jobs  in  the  early  thirties. 
It  was  a  long,  barren  period.   He  kept  going  for  about  fifteen 
years,  I  guess.   He  would  go  from  one  thing  to  the  next,  and 
particularly  because  of  his  carpenter-type  skills,  he  could 
always  find  something;  and  he  worked  cheaply.   He  did  what  he 
could. 

Crawford:   And  he  kept  organizing? 

Blum:      No.   Something  happened  to  him  during  these  years  and  he  lost 
all  interest  in  everything  political  and  cultural.   He  stopped 
reading.   He  didn't  bother  about  organizing  or  politics,  he 
just  kept  alive. 

Crawford:   Was  he  pleased  when  you  came  to  the  university? 

Blum:      I  don't  know  that  I  ever  heard  a  word  from  him  on  the  subject. 
He  wasn't  actively  opposed.   It  was  clear  that  he  thought  maybe 
I  should  stay  on  the  farm,  but  there  was  nothing  to  stay  on. 
So,  we  really  parted  company  pretty  thoroughly.   I  hated  him. 
He  was  vicious  to  my  mother  from  time  to  time.   I  didn't 
hesitate  to  threaten  to  shoot  him,  once.   I  thought  that  would 
be  a  good  move.   It  wouldn't  have  been,  I  guess,  but--. 


39 


Crawford:   Were  you  serious? 

Blum:      Oh,  yes. 

Crawford:   You  were  defending  your  mother,  I  suppose. 

Blum:      Yes.   I  wouldn't  go  for  that  sort  of  thing.   I  had  a  lot  of 
guns,  having  lived  on  a  farm,  went  hunting. 

Crawford:   Did  you  hunt  and  fish  together—the  two  of  you? 
Blum:      Never.   He  had  no  interest  in  that. 
Crawford:   He  was  not  an  outdoorsman,  I  guess. 

Blum:      Not  really.   He  worked  on  the  farm,  and  loved  being  outdoors, 
but  in  regard  to  sport,  no.   None  of  that.   He  wouldn't  object 
to  my  going  deer  hunting,  or  this  hunting,  or  that  hunting,  or 
fishing;  but  he  never  did. 

Crawford:   Well,  let's  talk  about  your  piano  studies.   We  need  to  go  back 
to  that  because  I  know  you  were  serious  about  music. 

Blum:      Well,  I  really  was,  and  I  wasn't.   I  had  a  wonderful  teacher  in 
the  town.   Lessons  also  had  to  be  fitted  in  on  Saturdays. 

Crawford:   How  did  you  get  into  town? 
Blum:      There  was  a  car. 

Crawford:   You  had  a  car?   And  you  devoted  Saturdays  to  all  these 
different  things?  The  library--. 

Blum:      All  these  things.   So  while  my  father  was  here  and  there  and 
elsewhere  doing  the  bulk  of  the  shopping--my  mother  would  go 
once  a  month,  while  he  and  I  would  go  every  Saturday.   So  I'd 
go  get  lessons.   It  was  an  hour.   It  cost  a  dollar  an  hour. 

Crawford:   Do  you  remember  a  name? 

Blum:      Yes.   Miss  Leah  Grigsby.   There  was  a  Mrs.  and  a  Miss,  and  I 
had  Miss.   Mrs.  was  not  related  to  Miss,  and  they  were  always 
competing,  which  was  kind  of  funny.   Each  had  a  large 
following.   I  loved  my  teacher  because  she  was  kindly.   Some 
people  loved  the  other  lady  because  she  was  so  stern  and 
disciplined.   I  didn't  go  for  that  at  all.   My  teacher  would 
have  a  hyacinth  picked,  or  something,  sitting  on  the  piano  that 
you  could  smell.   She  was  a  very  human  human  being,  and  she 
would  buy  me  presents  of  sheet  music.   She  had  two  lovely 


uprights.   So,  on  occasion,  we'd  both  play.   I  was  technically 
rather  proficient,  but  I'm  not  a  musician.   I  mean,  I  can't 
play  without  music.   I  could  memorize  something  but  it  was  a 
grueling  investment. 

Crawford:   Did  you  practice? 

Blum:      About  an  hour  a  day.   There  wasn't  any  let-up  on  that.   My 

mother  saw  to  that.   [laughs]   I  don't  know  that  I  hated  her 
for  it,  but  I  just  didn't  enjoy  it.   Everybody  else  was  out 
playing,  and  at  prime  time,  I  had  to  go  in  the  house  and 
practice.   I  did  well  enough.  After  four  months'  lessons  I 
went  on  to  recital.   My  teacher  had  a  big  recital,  and  I  played 
a  tiny  piano  part  of  "II  Trovatore." 

Crawford:   That's  ambitious. 

Blum:      I  sat  there  playing  the  gypsy  chorus.   It's  a  couple  of  notes 
up  and  a  couple  notes  down;  but  there  I  was,  about  so  big. 

Crawford:   How  old  were  you  when  you  started? 

Blum:      I  suppose  four  or  five.   So  that  was  a  great  success, 
tantalized  everybody  into  thinking  I  was  going  to  be  a 
musician.   At  four  months  it  looked  good.   I  stayed  with  it  for 
seven  or  eight  years  until  we  went  broke.   Part  of  the  ritual 
in  fruit  season  was  a  box  of  cherries  one  week,  one  week  a  box 
of  apples,  another  a  box  of  apricots,  a  box  of  grapes  for  my 
teacher. 


Crawford:   Your  teacher? 

Blum:      My  piano  teacher  always  got  something.   We  liked  giving  things 
to  her.   I  got  to  high  school  in  '27.   The  Depression  was 
starting  to  be  visible.   We  didn't  have  any  money  anymore.   So 
I  stopped  taking  the  lessons,  went  through  high  school,  and 
never  touched  the  piano. 

I  started  Cal  in  '31,  and  then  at  the  end  of  the  first 
semester  I  took  a  year  off  because  I  was  broke,  all  my  savings 
were  gone,  and  I  wasn't  doing  very  well.   I'll  tell  you  about 
that  experience.   So  I  stayed  out  a  year;  and,  in  that  year,  I 
just  picked  fruit,  got  jobs  here  and  there,  worked  on  a 
dehydrator,  packing  boxes,  set  tombstones.   I  was  getting 
pretty  husky  then.   I've  shrivelled  a  lot  since  then. 


Music  Studies  and  Cultural  Exposure 


Crawford:   Were  you  tall  as  a  very  young  person? 

Blum:      No,  tiny,  tiny.   I  got  to  be  about  6 "2",  ultimately.   In  my 

year  out  of  high  school  I  did  all  kinds  of  work  around.   In  my 
spare  time,  I  ran.   I  built  some  gymnastic  equipment  and  used 
that  for  an  hour  a  day,  and  I  practiced  the  piano  three  or  four 
hours  a  day.   It  had  two  broken  strings,  which  we  couldn't 
afford  to  fix. 

Crawford:   This  was  your  upright? 

Blum:      Yes.   I  got  quite  proficient.   I  finally  bought  a  lot  of  good 

music,  and  I  studied  the  Beethoven  concertos.   Real  music  never 
deserted  me--I  mean,  the  technical  proficiency.   I  didn't 
practice  for  years  at  a  time,  didn't  touch  a  piano  for  years  in 
medical  school.   But  my  mother  got  her  money's  worth  out  of  it. 
She  knew  that  I  could  play;  and  ultimately,  when  I  first  got  to 
be  a  health  officer  we  bought  a  new  house  and  we  built  her  an 
apartment  as  part  of  it.   She  got  to  hear  me  play  on  a  good 
piano  after  all  those  years. 

Crawford:   That's  great.   She  must  have  been  very  pleased  about  that. 

Blum:      I  don't  remember  that  she  ever  said  anything,  but  I'm  sure  she 
was . 

When  I  was  going  to  Cal,  I  lived  in  a  terrible  boarding 
house  across  from  the  Durant  Hotel.   The  head  of  the  music 
department  at  Mills  College  lived  in  that  hotel.   It  seems  to 
me  her  name  was  Mrs.  Swayze.   She  heard  me  playing,  and  she 
came  over,  knocked  on  the  door  and  invited  me  to  come  and 
practice  in  her  apartment.   She  had  a  beautiful,  big  Steinway 
right  there.   She  had  a  large  suite  of  rooms,  and  she  made  her 
home  there.   So,  I  did  that  once  in  a  while.   It  was  better 
than  that  terrible  piano  at  the  boarding  house,  and  no  one  to 
heckle  me  for  playing  classics.   Those  were  some  of  the  few 
good  moments  that  I  got  out  of  it.   There  also  was  a  wonderful 
piano  on  the  campus  in  Stevens  Hall.   It  was  a  gorgeous 
Steinway:  unusual  colored  wood,  a  wonderful  tone.   I  used  to  go 
up  there  on  Sunday  mornings.   With  nobody  around  you  could 
play.   Finally,  it  became  popular.   There  were  always  groups 
meeting  there,  but  my  first  year  here  in  '31  I  did  play  on  it. 

Crawford:   You  mentioned  the  blue  books,  the  little  blue  books. 


42 


Blum: 


Oh,  that  was  an  interesting  part  of  my  life  on  the  farm,  yes. 
Those  were  a  nickel  and  a  dime  a  piece,  and  in  that  Petaluma 


Crawford: 


Blum: 


Crawford: 
Blum: 


Crawford: 

Blum: 

Crawford: 

Blum: 

Crawford; 


book  they  discuss  them.   I  mean, 
book  after  I  talked  to  you.) 


it's  all  there.   (I  got  that 


Maybe  you  had  just  heard  of  it  when  we  talked  because  I  made  a 
note  of  it,  but  you  hadn't  seen  it. 

I  don't  know,  a  friend  just  gave  it  to  me.   In  any  event,  I 
remember  the  blue  books  because  we  had  stacks  of  them  in  the 
basement.   We  had  a  room  down  there  which  was  built  as  a 
sleeping  room.   We  used  to  give  hoboes  a  ride  when  my  father 
would  drive  along.   Most  of  the  hoboes  in  those  days  were  folks 
that  came  out  of  the  skilled  trades  —  there  was  the  IWW. 

Where  did  you  find  them? 

Oh,  on  the  road  when  traveling  to  town  or  to  Sonoma  or  to 
wherever  we  were  going,  we'd  see  these  people.   They  would  be 
walking  along  with  a  small  bundle.   You'd  stop  and  ask  them  if 
they  wanted  a  ride,  wanted  to  go  anywhere.   Often  enough,  these 
people  had  work  experience  in  common  with  my  father:  they  were 
mechanics,  woodworkers,  one  thing  or  another.   So  some  of  them 
would  say,  "Yes,  I  wouldn't  mind  staying  on  the  farm  for  a 
while."  And  my  father  would  say,  "Well,  stay  for  a  while,  and 
if  you  want  to  work,  I'll  pay  you,  if  there's  work  to  do,"  and 
there  often  was  for  brief  periods. 

We  used  to  hire  some  day  laborers  to  do  this  and  do  that, 
particularly  if  my  father  was  doing  cabinet  work.   So  some  of 
these  people  lived  in  this  room,  and  that's  where  the  blue 
books  were.   Sometimes  I'd  get  into  conversations  with  them 
about  these  books.   The  blue  books  were  all  excerpts  from  the 
world's  famous  literature:  philosophic,  political,  and  the 
romantic  literature.   Although  I  had  plenty  of  library  books, 
these  books  were  kind  of  a  kick  because  they  were  so  diverse, 
you  could  cover  a  lot  of  territory—in  a  few  minutes  one  could 
see  what  an  author  had  to  say  from  a  key  excerpt. 

Excerpts?  They  were  excerpts? 

Excerpts.  Yes. 

Who  published  those? 

The  word  Haldeman  comes  to  mind,  but  I'm  not  sure. 

Haldeman.   But  your  father  collected  those,  did  he? 


Blum:      Well,  he  went  to  the  city  and  to  meetings,  and  if  he  saw  one, 
it  was  no  more  than  a  nickel  or  a  dime,  the  price  of  a  candy 
bar  or  a  package  of  peanuts.   In  Petaluma,  the  blue  books  were 
evident  as  a  very  common  institution.   But  our  big  affair--my 
mother  and  I--was  to  go  to  the  city  and  take  in  something  that 
was  big  time  culturally. 

Crawford:  Do  your  remember  what  you  saw? 

Blum:  Oh,  yes.   Caruso--. 

Crawford:  Oh,  you  heard  Caruso? 

Blum:  Yes.   Geraldine  Farrar,  Ezio  Pinza,  Chaliapin. 

Crawford:  Where  were  they  singing? 

Blum:      The  Civic  Auditorium.   All  the  great  performers.   One  thing  we 
did  have,  and  nobody  else  in  our  neighborhood  had,  was  a  good 
phonograph.   We  had  all  the  classical  records  that  cost  three 
dollars  if  they  were  on  one  side,  and  four  or  five  dollars  if 
they  were  on  both  sides. 

Crawford:   That's  a  vast  amount. 

Blum:       In  fact,  a  vast  amount.   So  there  was  everybody:  Gallicurci, 
Heifetz,  Rubenstein,  all  the  great  singers  and 

instrumentalists.   A  friend  of  mine,  without  knowing  about  this 
part  of  my  existence  at  all—he's  a  collector  —  has  brought  me 
several  volumes  about  all  the  old  opera  performances  and  the 
singers;  the  pictures  and  the  events. 

Crawford:   And  the  recordings? 

Blum:      No,  I  have  some  of  the  recordings  left  over  from  the  farm,  but 
they're  so  grim.   I  mean,  who  can  waste  the  time  that's 
involved?   Every  three  minutes  you've  got  to  change  the  record; 
and  they're  technically  terrible.   Well,  we've  still  got  a  box 
of  them. 

Crawford:   Seventy-eights? 

Blum:      Seventy-eights,  but  I  don't  listen  to  them.   Five  years  ago  I 
got  rid  of  the  last  device  that  we  had  that  would  even  play 
them.   Ordinary  players  don't  do  seventy-eights.   Well,  I 
finally  got  rid  of  it.   It  failed,  and  I  just  gave  it  up.   But 
I  remember,  those  were  the  days  when  Gigli  was  a  young  man,  and 
Schipa  was  a  young  man.   I  go  through  these  old  books  about 


opera  now,  and  relive  it. 
see  their  faces. 


You  sort  of  hear  these  people  as  you 


Crawford:   They  don't  come  like  that  anymore. 

Blum:      They  do  and  they  don't.   There  are  fabulous  voices  now,  just 

fabulous;  but  those  were  hard  times.   You  could  go  to  the  opera 
house  and  hear  them  once  in  a  while,  and  then  the  seventy- 
eights  helped  you  relive  the  real  events. 

Crawford:   Coming  to  San  Francisco  was  a  day-long  visit,  wasn't  it? 

Blum:      Yes.   We'd  be  there  for  a  couple  of  days,  and  we  stayed  with  a 
woman  that  my  mother  knew  from  Russia.   She  lived  across  the 
street  from  Mission  Dolores.   It's  a  beautiful  spot,  really. 
Lo  and  behold,  my  neighbor,  now—for  the  last  thirty  years- 
turns  out  to  be  the  niece  of  that  lovely  old  lady. 


II   COMING  TO  UC  BERKELEY:  UNDERGRADUATE  STUDIES,  1931-1937 


From  Engineering  to  Chemistry 


Crawford: 


Blum: 


Crawford: 
Blum: 


Crawford; 
Blum: 


What  a  coincidence, 
be  an  engineer? 


Well,  by  now  you  decided  you  were  going  to 


An  engineer,  and  that's  how  I  got  to  Berkeley.   The  university 
made  a  few  exceptions  on  my  account  because  my  grades  were  not 
very  good.   I  only  got  good  grades  when  I  was  minded  to.   The 
principal  vouched  for  me.   The  high  school  had  a  bad 
reputation,  then.   The  university  didn't  want  to  take  students 
from  Napa  High,  but  it  had  a  new  superintendent—or  principal-- 
and  he  was  a  fuss-budget,  and  he  really  turned  the  school 
around.   I  was  one  of  his  new  products  even  though  my  grades 
weren't  so  hot.   So  I  got  in.   The  first  thing  I  did  here  was 
flunk  Subject  A.   I  hadn't  done  a  lot  of  writing,  actually,  but 
was  thought  to  be  pretty  good  at  it.   That  was  kind  of  a  shock. 

In  high  school? 

Yes.   In  high  school.   I  was  sort  of  a  teacher's  pet  there, 
too,  because  I  knew  stuff  that  nobody  else  ever  heard  of;  when 
you  enter  the  world  of  literature,  there's  a  lot  of  things  you 
know.   I  had  a  wonderful  English  teacher,  her  name  was  Blume  of 
all  things,  a  tiny  little  darling  woman  whom  I  saw  in  recent 
years  and  she  was  still  a  tiny  little  darling  woman  who 
remembered  me. 

From  Napa? 

She  actually  was  from  Berkeley,  originally,  as  it  turned  out. 
She  went  there  to  teach  school  when  she  graduated  UCB.   She 
wasn't  much  older  than  we  were,  and  a  marvelous  teacher,  so  I 
had  a  great  time  with  that.   Well,  I  came  to  the  university, 


here,  and  the  first  thing  I  did  was  flunk  Subject  A. 
not  too  highly  thought  of. 


That ' s 


46 


Crawford: 
Blum: 


On  my  first  day  of  school,  I  went  over  to  engineering, 
that's  where  I  was  going  to  be,  and  I  went  to  take  Civil 
Engineering  1A.   They  had  a  brand  new  building  called  the 
Engineering  Building—that  nice  marble-looking  building—but  in 
the  catalogues  that  we  were  given,  the  instructions  showed  all 
the  rooms  for  the  engineering  classes  in  a  building  that  had 
been  shut  down,  and  they  hadn't  modified  the  books.   So  I  went 
up  to  old  North  Hall,  which  used  to  be,  I  think,  where  the 
engineers  were.   It  was  an  old  building  that  was  just  on  the 
verge  of  being  torn  down,  and  it  was  locked  up. 

I  looked  around,  and  finally  asked  some  people,  and  they 
said,  "Oh,  well,  I  think  engineering's  right  over  there."   So  I 
got  there  about  half  an  hour  late— with  three  others  — and  it 
was  our  first  day  of  school.   In  those  days  you  didn't  pre-sign 
up.   They  had  a  sign-up  in  terms  of  paperwork,  but  you  enrolled 
in  class  the  first  day  of  school. 

I  got  there  and  they  said,  "Well,  we're  very  sorry.   There 
are  no  more  transits— the  survey  instrument  that  you're  going 
to  use  in  the  course— there  are  no  more  measuring  tapes,  and 
there  are  no  more  levels,  and  there  are  no  more  desks."  This 
was  '31,  and  being  an  engineer  was  serious  business  for  a  lot 
of  people.   Well,  they  thought  maybe  somebody  would  drop  out. 

So  the  four  of  us— which  is  the  size  of  a  work  group— used 
to  go  up  in  the  hillsides  up  where  Bowles  Hall  is  now;  there 
used  to  be  cattle  there.   We  "measured"  from  one  cow  flop  to 
the  next,  you  know.   This  was  the  pasture;  but  these  other 
people  had  tools  with  which  to  do  the  measurements. 

So  we  measured  with  our  feet.   It  was  a  joke,  a  bad  joke. 
We'd  come  in  and  we'd  get  an  F— or  a  zero.   Just  like  we'd  done 
a  bad  job.   Then  we  sat  in  class  and  listened  to  the  comments, 
and  for  four  weeks  we  got  zeroes.   It  was  clear  that  nobody  was 
dropping,  it  was  time  to  quit  because  we  weren't  going  to  get 
any  equipment  and  we  were  going  to  fail  in  the  basic  course  of 
our  chosen  career,  perhaps  get  flunked  out  of  Cal  as  well. 

Find  a  new  major. 

Right.   This  was  Cal,  very  impersonal,  nobody  gave  a  damn.   So 
I  went  up  to  the  professor.   He  was  a  very  handsome,  powerful- 
looking  middle-aged  man  by  the  name  of  Wiskocil.   I  said,  "I'm 
going  to  have  to  drop."  He  said,  "Yes.   We're  just  glad  to  see 
you  go."   I  was  fifteen  years  old.   That  was  the  end  of  my 
career  as  an  engineer. 


Crawford:   What  an  attitude. 


47 

Blum:      So,  I  switched  to  chemistry. 
II 

Blum:      Thinking  back,  I  had  had  a  wonderful  chemistry  teacher  in  high 
school.   I  took  physics,  mechanical  drawing,  art--which  was 
truly  an  experience.   It  took  a  year  for  me  to  draw  one  tulip, 
and  it  didn't  look  like  too  much.   [laughter] 

Crawford:   You  weren't  cut  out  to  be  draftsman? 

Blum:      No.   So,  leaving  engineering  probably  worked  out  for  the 

better.   So  I  started  off,  but  now  I  had  a  gap  of  four  units, 
and  it  was  too  late  to  make  it  up.   Of  course,  one  can  make  it 
up  in  due  time.   Then  I  forgot  my  Subject  A  class.   I  got  so 
busy  with  chemistry—it  involved  labs  three  times  a  week,  and 
I'd  stay  there  as  long  as  I  could,  I  was  having  a  good  time-- 
and  that's  when  I  was  supposed  to  be  taking  the  Subject  A 
course  at  four  o'clock  three  days  a  week. 

Crawford:   That  was  English? 

Blum:      English  composition,  yes.   So  I  woke  up  about  the  end  of  the 
semester,  and  I  trotted  over  there  to  the  last  Subject  A 
class,  and  the  teacher  said,  "I  remember  your  name.   You  signed 
up.   What  happened  to  you?"   I  said,  "I  forgot  about  it.   I've 
been  in  these  labs--these  chem.  labs--and  I  suddenly 
remembered."   "Well,"  she  said,  "I'll  tell  you  what,  you  can 
take  our  final  exam,  and  we'll  see  how  you  do.   You  can  always 
take  it  over  again  next  year."   So  I  took  it,  and  I  got  an  A  in 
it,  don't  ask  me  why. 

Crawford:   Reading? 

Blum:      It  was  writing,  not  reading.   But  I  had  forgotten  about  it 

because  I  was  doing  chemistry.   So  the  chemistry  was  pleasant, 
and  a  lot  of  hometown  kids  were  there,  a  very  industrious  crew, 
mostly  sober  with  a  few  interesting  exceptions.   Alcoholism  was 
rampant  in  those  days,  even  amongst  chemists. 

Crawford:   Now  you're  talking  about  student  life,  and  drinking  among 
students? 

Blum:      Yes.   That  kind  of  steered  me  away  from  some  of  those  groups; 
but  we  didn't  have  always  the  best  faculty  examples.   I 
remember,  we  had  two  Scotchmen  on  successive  lectures,  famous 
men—one  of  whom  I  couldn't  enjoy.   He  was  such  a  prissy 
character.   The  other  one  I  just  loved.   He  was  a  hard-drinking 
guy. 


Crawford:   Real  Scots? 

Blum:      Real  Scots,  oh  yes,  red  hair,  everything.   We  came  in  the 

classroom  one  morning,  and  the  first  professor- -the  fussy  one 
who  never  smiled  or  anything,  just  steely-eyed,  all  business, 
probably  a  nice  guy--and  we  all  smelled  gas.   He  said,  "There 
are  a  lot  of  metal  plates  here,  and  some  of  you  have  metal 
cleats  on  your  shoes.   Take  it  easy,  let's  not  have  an 
explosion."   So  we  sat  through  our  class.   The  next  Scotchman 
comes  in  and  [makes  sniffing  sound]  he  said,  "I  smell  gas,"  and 
he  gets  out  his  cigarette  lighter  and  he  goes  around  looking 
for  the  leak.   [laughter]   These  are  two  separate  worlds.   The 
second  man,  of  course,  was  the  man  who  liked  to  drink.   He  was 
truly  an  imaginative,  lovely  human  being.   I  did  some  research 
with  him  in  later  years. 

Crawford:   What  was  his  name? 

Blum:      Gerald  Branch—a  great  guy.   The  story  went  that  he'd  fallen 
into  the  Strawberry  swimming  pool  more  than  once.   Any  event, 
it  was  a  nice  educational  experience,  and  Cal  was  probably  the 
elite  chemistry  school  in  the  United  States. 

Crawford:   You  were  close  to  these  professors,  then,  as  an  undergraduate? 

Blum:      Fairly  close;  if  you  were  a  good  student,  and  they  got  to  know 
you,  it  was  just  that  simple.   I  was  good  enough.   I  wasn't  as 
good  as  the  best,  but  I  was  pretty  good.   I  started  realizing, 
though,  that  there  were  some  that  were  so  much  better.   Truly, 
their  minds  were  good,  good,  good.   I  didn't  want  to  be  a 
second-rate  chemist;  and  that's  what  I  would  be.   Most  of  my 
classmates  who  did  about  as  well  as  I  did  ended  up  doing  tests 
for  the  oil  companies  out  here.   I  didn't  see  that  as  a  career. 
So  I  started  looking  around  for  some  applications  in  biology  in 
particular.   That  seemed  to  make  sense  to  me.   I  took 
bacteriology  and  just  loved  it  and  met  some  wonderful  people, 
like  the  recent  dean  of  the  graduate  school,  Sanford  Elberg. 

He  was  a  T.A.  in  my  student  days.   We  had  a  great  time.   I 
was  making  a  point  then,  of  getting  the  best  grade  in  the  class 
by  knowing  the  most.   It  was  kind  of  satisfying.   If  you're 
going  to  do  it,  do  it  right,  know  all  the  material.   Then  we 
went  on  to  more  advanced  courses,  and  the  advanced  course  was 
eight  units.   We  lived  in  this  lab  because  there  was  a  lot  of 
lab  work.   We  were  there  day  and  night,  practically.   I  loved 
it.   Tonight  I'll  meet  with  a  nephew  of  the  student  who  was  my 
lab  partner  in  that  course. 

Crawford:   So  you've  stayed  in  touch? 


Blum: 


Crawford : 
Blum: 


Yes.   Sort  of  long-range,  but  we  did.   I  met  my  wife  there  as 
well.   Her  older  sister  was  a  bacteriologist  and  had  a  close 
friend  working  on  her  Ph.D.  in  bacteriology  who  shared  the  lab 
with  us  at  night  as  we  worked  on  our  experiments.   Marian  and 
this  friend  of  her  sister's  were  both  in  a  botany  course  and 
studied  together  in  the  lab  every  few  nights. 


Was  she  in  the  sciences? 

No,  she  was  in  social  work,  an  undergrad  program, 
freshman  and  I  was  a  senior. 


She  was  a 


Perry  R.  Stout  and  Daniel  Arnon:  Mentors 


Blum: 


Crawford : 
Blum: 


Crawford: 
Blum: 
Crawford; 
Blum: 


In  that  high-powered  bacteriology  course  were  all  the  future 
hot-shot  biologists.   I  made  up  my  mind  that  I  would  do  better 
than  anybody  else  —  and  did—for  which  one  sort  of  gets  marked 
out.   But  this  is  no  longer  grammar  school.   Now  you're 
amounting  to  something,  and  to  beat  out  all  the  folks  who  had 
it  made  —  for  instance,  one  of  the  professors  of  zoology  who 
then  was  a  doctoral  student;  and  I  wasn't  a  doctoral  student, 
but  I  just  kept  getting  better  results  than  he  did.   It  made  me 
feel  good  because  he  was  the  anointed  one  there.   I  discovered 
that  I  was  good  at  something,  but  it  wasn't  chemistry. 
However,  I  later  went  on  to  work  for  a  group  of  chemists  here, 
some  famous  ones,  in  plant  nutrition.   One  was  Daniel  Arnon. 
He  came  close  to  getting  a  Nobel. 

What  was  Arnon 's  field? 

He  was  a  chlorophyll  metabolism  expert,  an  expatriate  from 
Poland.   Then,  I  worked  for  a  fantastically  wonderful  guy- 
Perry  R.  Stout,  who  became  a  big  wheel  at  UC  Davis  in  due  time. 
These  people  did  the  most  interesting  experiments;  and  there  I 
was,  the  hired  hand  as  a  chemist,  fifty  cents  an  hour.   You 


day.   That's  how  I  saved 


might  work  eighteen  to  twenty  hours  a 
money  to  get  to  medical  school. 

You  were  working  on  their  projects? 
On  their  projects,  yes. 
As  a  research  assistant? 


Assistant.   Much  of  it  was,  "Hey,  run  these  potassiums,  run 
these  sodiums,  go  feed  the  tomatoes,  do  this,  do  that."   So  you 


50 


were  a  gopher.   But  on  the  other  hand,  if  you  had  brains  enough 
to  cook  something  up,  you  might  be  allowed  to  do  it;  but  that 
wasn't  what  you  were  there  for.   Stout—particularly  Stout  —  did 
the  most  fantastic  experiments;  and  he  only  belatedly  got 
credit  for  them  because  his  experiments  were  seen  as  "too 
easy."   I'll  never  forget  that. 

Crawford:   What  do  you  mean? 

Blum:      Well,  he  was  trying  to  get  a  Ph.D.,  while  he  ran  the  storeroom 
for  the  Department  of  Plant  Nutrition,  for  which  he  got  about 
one  hundred  and  ten  dollars  a  month.   Then  he'd  do  all  this 
stuff.   He  was  the  man  who  discovered  what  happened  to  the 
added  phosphates  in  some  phosphate-depleted  soils.   This  was  a 
great  mystery  to  everybody.   The  farmers  pumped  on  the 
phosphate  and  the  trees  blossomed.   But  the  next  year,  the 
trees  declined.   On  an  analysis  of  the  soil,  "It's  there,  but 
why  don't  the  trees  get  it?"   Well,  he  figured  out  just  exactly 
what  the  crystalline  structure  of  the  soil  was,  and  that 
particular  soil  absorbed  the  phosphate  into  a  new  crystalline 
format  where  it  became  unavailable  to  the  trees. 

Crawford:   So,  after  initial  application,  it  wasn't  there? 

Blum:      It  wasn't  there  for  the  trees  to  get  it.   It  had  been  a  great 
mystery.   Perry  R.  did  all  this  work  with  crystallography  and 
x-ray  diffraction  patterns.   He  had  taught  himself  mineralogy. 
He  was  no  mineralogist,  he  was  an  agricultural  chemist.   I'll 
never  forget,  he  sent  away  to  the  USDA  for  soil  specimens- -or 
mineral  specimens— because  he  was  learning  how  to  do 
diffraction  patterns  on  the  x-ray. 

He  established  the  diffraction  patterns  of  the  well-known 
minerals  that  the  USDA  had  sent  to  him.   He  got  the  diffraction 
patterns,  but  one  of  them  doesn't  come  out—one  of  these  from 
the  USDA— all  labelled  and  everything.   So  he  does  it  again. 
He  assumes  he  may  have  miscalculated  or  mislabelled  that 
sample.   Again,  it  came  out  with  this  wrong  pattern.   So  he 
figured  out  what  it  really  was,  and  he  wrote  back  to  the  USDA 
saying,  "You  know,  the  sample  you  sent  me  as  thus-and-so  is 
really  not  thus-and-so,  but  is  something  else  with  the 
structure  I've  established."   He  became  a  hero  overnight.   USDA 
had  never  been  able  to  identify  what  that  specimen  was,  and 
they  told  him  that.   He  was  using  relatively  new  technology— x- 
ray  diffraction  patterns,  you  see— and  they  were  using 
something  else.   Well,  he  went  around  the  world  before  it  was 
over,  explaining  this  way  of  doing  business  and  this  wonderful 
experiment.   He  just  did  one  exciting  thing  after  another. 


51 


Crawford:   He  was  a  Ph.D.  candidate? 

Blum:      Candidate.   He  never  got  a  Ph.D.  because  his  committee  would 
sit  there  and  say,  "Well,  you  only  worked  on  that  for  two 
months,  you  can't  get  a  Ph.D."   So,  he  went  from  one 
spectacular  thing  to  the  other,  and  he  never  spent  more  than  a 
couple  of  months  doing  them.   True,  he'd  spend  maybe  six  months 
or  a  year  thinking  about  it,  but  when  he  hit  the  lab,  it  was 
all  streamlined  with  all  the  options  laid  out.  He  did  work 
with  radioactive  material  that  was  then  commencing  to  be  "the 
thing,"  and  Perry  R.  was  finding  new  isotopes  every  day.   He 
and  I  would  work  on  them,  and  he  was  just  an  absolute  genius. 
He'd  say,  "Well,  if  it  is  in  the  filtrate,  it's  this;  and  if 
it's  in  the  residue,  it's  that."   I  hardly  kept  up  with  him. 

I'm  just  reading,  now,  the  life  of  Lisa  Meitner,  the  famous 
German  physicist  who  worked  in  the  area  of  radioactivity,  and 
had  exactly  the  same  sort  of  responses  to  her  findings.   Here 
Perry  R.  Stout  was  banging  it  all  out,  and  he's  not  even  a 
physicist. 

That  further  convinced  me  that  I  didn't  want  to  be  a 
chemist.   I  told  him  when  I  left,  "Perry  R. ,  you  work  one  hour 
a  day  extra,  and  that  will  take  care  of  everything  I  ever  would 
have  contributed."   I  mean,  that's  the  relationship:  about  1:8 
in  terms  of  capacity. 

I  worked  with  him  a  lot.   We  used  to  go  up  all  through  the 
Sutter  bypass,  that  floods  each  spring.   He  was  a  consultant. 
He'd  make  one  major  trip  a  year.   We'd  get  in  his  old  car,  go 
up  there  and  take  soil  specimens  and  water  specimens.   From  our 
analyses  of  the  specimens  he'd  tell  the  farmers  what  to  put  on 
their  crops,  how  much  to  irrigate,  what  to  do,  what  not  to  do. 
I  would  do  all  the  analyses  here;  but  he  was  the  one  who 
figured  out  what  they  should  do  about  their  crops,  each  of 
which  had  different  needs. 

That  was  a  marvelous  experience  with  a  real  scientist. 
Then,  when  the  war  came  along,  I  knew  that  he  was  in  D.C.   I 
was  stationed  nearby  in  Baltimore.   So  I  went  over  to  see  him. 
He  was  in  the  old  Bureau  of  Standards  Building;  and  I  came  up, 
and  I  was  in  uniform.   The  marine  guard  there  said,  "What  can  I 
do  for  you?"   I  said,  "I  want  to  see  Perry  R.  Stout."   "Oh, 
fine,"  he  said,  "just  wait  a  minute."  He  disappeared  for  a  few 
minutes,  and  there  comes  Perry  R.  Stout.   He's  a  great  big  man, 
and  he  looks  at  me,  and  he  says,  "How  did  you  get  in  here?"   I 
said,  "I  told  the  guard  that  I  wanted  to  see  you."  He  said, 
"That  same  guard—he  kept  the  British  Radar  Scientific 
Delegation  waiting  for  a  week  before  he  would  even  tell  them 


52 


that  I  was  here."  And  what  is  he?  He's  the  head  of  all  the 
radar  research  in  the  world,  exclusive  of  the  German  efforts. 

When  they  hired  him—he  still  didn't  have  his  Ph.D.,  but 
somebody  knew  that  he'd  done  his  x-ray  diffraction  work,  he'd 
built  radar-type  equipment,  he'd  built  geiger  counters,  pH 
meters.   He  just  made  these  things  in  passing  because  he  couldn't 
afford  them  or  they  weren't  available  and  he  needed  them. 

Scientists  had  heard  about  him  and  shipped  him  to  Harvard, 
where  the  radar  program  was  starting.   On  his  first  day  there- 
he's  a  big  burly  guy--he  dropped  the  one  piece  of  radar 
equipment  they  had  and  broke  it  to  smithereens;  and  they  just 
lost  their  minds.   He  said,  "Look,  just  relax.   I'll  put  it 
together  by  morning.   Just  don't  wear  yourself  out."  And  he 
did.   Well,  they  didn't  even  know  how  to  put  it  together  after 
he  put  it  together. 

In  short  order  he  became  the  head  of  all  radar  research  for 
the  Allies.   They  moved  him  to  the  Bureau  of  Standards  and  gave 
him  this  building  for  a  place  to  work,  but  he's  still  earning  a 
hundred  and  forty  dollars  a  month  because  they  had  a  deal  with 
universities  that  they  wouldn't  pay  any  more  than  the  person 
was  getting  when  he  was  drafted.   This  is  the  University  of 
California  at  Berkeley  at  its  best.   He  couldn't  make  his  Ph.D. 
in  about  five  attempts,  each  of  which  brought  him  world 
recognition. 

Crawford:   Would  that  happen  today? 


Blum:      I  suspect  that  it  might.   But  the  armed  forces  told  the 

university,  "We're  going  to  pay  him  what  we  think  he  has  to 
have.   As  the  head  man  here,  he's  going  to  get  the  head  pay, 
whether  you  like  it  or  not,  whether  we  have  an  agreement  or 
not."   So  he  earned  a  decent  salary  for  the  first  time  in  his 
life.   We  went  to  his  house  and  had  a  drink.   It  was  quite 
something.   A  couple  of  kids  —  three  kids  — and  living  on  nothing 
all  this  while.   He  didn't  much  care.   He  was  a  real  scientist. 
Well,  the  university  figured  the  only  way  out  of  that 
embarrassment  was  to  give  him  his  Ph.D.,  and  they  did. 

Crawford:   Oh,  so  they  did? 

Blum:      They  did.  They  cooked  up  something.  They  gave  him  a  Ph.D.  on 
one  of  the  studies  that  he  was  already  famous  for.   I  remember, 
when  he  flunked  one  of  his  doctoral  exams- -he  flunked  it- -well, 
the  real  point  was  that  he  hadn't  spent  enough  time  on 
conquering  the  phosphate  project.   I  remember  Dr.  Greenberg, 
the  great  biochemist,  had  flunked  him  ostensibly  because  he 


53 


Crawford : 
Blum: 

Crawford: 
Blum: 

Crawford: 
Blum: 

Crawford : 
Blum: 
Crawford: 
Blum: 


hadn't  memorized  the  structures  of  the  amino  acids.   Here,  the 
next  day,  I'm  working;  and  here's  Greenberg  sitting  at  Perry 
R.'s  desk  saying,  "Would  you  teach  me  how  to  do  these  x-ray 
diffraction  patterns  so  I  can  do  my  work?"  Can  you  imagine  the 
son  of  a  bitch?  He  had  really  flunked  Perry  R.  because  he  made 
important  research  look  too  easy. 

It's  pretty  surprising. 

I  knew  the  professor  because  I  had  taken  biochemistry,  and  he 
was  one  of  the  nicer  guys.  But  he  flunked  Perry  R.,  and  then 
wanted  Perry  R.  to  teach  him  how  to  do  his  own  work. 

Maybe  a  little  envy?   Sounds  like  it. 

A  little  something.  It  was  pretty  damned  odd,  yet  not  really 
unusual.  Other  examples  come  to  mind. 

What  happened  to  Perry  R.? 

Perry  R.  became  famous,  of  course.   He  ended  up  in  Davis  as  one 
of  the  department  heads.   He  died  there—prematurely,  I'm 
afraid. 

And  how  about  Arnon? 


Arnon  just  died  about  two  years  ago. 


Never  got  his  Nobel? 


One 


Didn't  get  his  Nobel,  but  had  a  tremendous  funeral  affair, 
of  his  daughters  was  one  of  my  favorite  health  planning 
students.   I  first  knew  her  when  she  was  a  baby  when  I  worked 
for  her  father,  but  years  later  she  came  through  public  health 
and  was  one  of  my  students  in  health  planning.   An  interesting 
woman  who  has  gone  out  to  Santa  Fe,  and  has  lived  there  ever 
since,  didn't  want  to  stay  here.   She  has  a  brother  who's  a 
well-known  doctor,  from  Stanford.   Kids  scattered  all  over  the 
world;  some  of  them  living  in  England. 

I  can't  resist  telling  you  about  Nancy.   In  the  week  before 
her  graduation  she  insisted  I  join  her  for  a  picnic  lunch  at 
the  Haas  Strawberry  Pool  on  campus.   She  would  take  us  in  her 
father's  car  and  bring  the  picnic.   When  we  got  there  she  had  a 
swimming  suit  and  towel  for  me  so  I  could  go  swimming  and  take 
a  sun  bath.   She  confessed  to  subterfuge,  she  felt  I  worked 
much  too  hard,  was  getting  pale,  and  she  wanted  me  to  relax  for 
a  couple  of  hours  at  least.   She  had  to  study  finals  and  would 


be  back  for  me,  and  I  couldn't  cheat  on  the  rest  because  she 
was  taking  the  car. 

Crawford:   They  were  sort  of  mentors  for  you  then,  the  two  of  them  when 
you  were  an  undergraduate? 

Blum:  Oh,  yes.   These  were  true  scientists  and  fine  persons,  yes. 

Crawford:  And  they  inspired  you  to  go  on  with  medicine? 

Blum:  Not  really.   Oh,  no.   We  never  mentioned  medicine. 

Crawford:  Thought  you'd  be  a  scientist? 

Blum:      Yes,  a  scientist,  but  my  observation,  particularly  where  it 

concerned  Stout,  was  that,  "I'm  just  wasting  everybody's  time. 
This  man  sees  so  much  better,  so  much  faster.   I'm  just  going 
to  waste  a  salary  and  a  spot  if  I  stayed  in  his  field." 


Choosing  a  Career 

[Interview  2:  January  28,  1997] 


Blum:      I  told  you  that  at  Cal,  I  was  fishing  for  a  career  that  would 
use  my  chemistry;  and  one  of  the  things  I  found  was  the  wine 
curriculum,  because  we  had  a  vineyard,  you  see.   I  took  all  the 
courses  on  campus  for  that.   That  was  in  about  my  third  year, 
when  I'd  done  basic  bacteriology.   I  had  a  good  time  there,  as 
I  was  trying  to  get  more  applied.   I  looked  into  the  winemaking 
business,  and  that  was  kind  of  fun.   But  just  like  being  a 
chemist  in  an  oil  plant,  you  do  a  thousand  tests  every  week. 
Forget  it. 

Crawford:   You  didn't  see  yourself  as  a  vineyard  owner? 

Blum:      Oh,  no.   Then  I  took  all  the  biochemistry  courses.   Finally,  I 
took  a  course  in  pharmacology.   I  said,  "Here  we  go.   This  is 
how  I'm  going  to  get  into  research  and  use  my  chemistry.   This 
is  going  to  be  it."   I  was  already  going  with  my  wife  and  it 
seemed  okay  to  her. 

When  I  graduated  from  chemistry  with  honors  and  was 
therefore  offered  a  job  at  Shell  Chemical  where  I  discovered 
barrel-rollers  were  paid  more  than  good  chemists,  I  said  to 
Marian,  "Let's  go  over  and  look  into  the  pharmacology  program 
at  UCSF.   It's  a  doctoral  program,  and  that  should  be  really 


55 


Crawford: 
Blum: 
Crawford: 
Blum: 

Crawford: 
Blum: 


Crawford: 
Blum: 


fun."  We  went  over  there,  and  the  professor  who  ran  the 
program  sat  us  down  and  explained  that  I'd  be  lucky  to  survive 
such  tough  studies  and  the  competition  from  medical  students  in 
the  basic  courses. 

This  must  have  been  during  your  senior  year? 
Just  at  the  end,  yes. 
And  who  was  he? 

Oh,  he  was  a  great  man.   He  was  a  dean  once  at  a  medical 
school,  Chauncey  Leake:  a  big  faker. 

How  do  you  mean  that? 

Well,  he  said  to  us--as  we  were  sitting  there,  out  in  the  sun 
in  San  Francisco--"!  don't  know  that  you  can  make  it.   You  see, 
you've  got  to  take  the  first  two  years  in  courses  of  the 
medical  school,  and  I  don't  know  that  you  can  get  through.   But 
sure,  we'd  like  to  have  you.   You  have  a  good  background  in 
chemistry  and  biochemistry.   Now  you  have  to  take  all  the 
courses  that  make  up  the  first  two  years  of  medical  school." 
It  turns  out  that  to  take  them  in  medical  school  will  cost 
seventy-five  dollars  a  semester;  taking  them  as  a  Ph.D. 
student,  in  those  days,  cost  twenty-five  dollars  a  semester. 
My  wife  got  very  upset  with  this  professor  because  he  repeated 
several  times  that  he  didn't  know  whether  I  could  make  it  or 
not,  getting  through  the  equivalent  of  the  first  two  years  of 
medical  school  in  competition  with  the  medical  students. 

Why?  You  were  head  of  your  class. 

Well,  but  neither  he  nor  I  knew  that  then,  that  was  yet  to 
come.   We  sat  and  thought  about  it.   If  you  take  the  first  two 
years  in  medical  school,  you  can  go  on  to  complete  your  M.D.  if 
you  want  to;  or  you  can  always  go  back  to  pharmacology.   If  you 
take  the  same  course  work  on  the  Ph.D.  track,  you  can  never  use 
it  to  complete  medical  school  because  you  weren't  enrolled  in 
medical  school.   Written  into  state  law  by  turf-oriented  M.D.s 
was  the  fact  that  you  had  to  take  these  courses  as  a  student 
registered  in  a  bona  fide  medical  school.   We  thought  about  it 
for  the  time  it  took  us  to  get  home.   I  said,  "The  hell  with 
that.   I'll  get  into  medical  school,  and  I  can  always  go  back 
to  pharmacology  if  I  don't  want  to  complete  the  M.D." 


Crawford: 


But  you  can't  go  the  other  way? 


56 


Blum:      You  can't  go  the  other  way,  and  the  difference  in  cost  is  only 
two  hundred  dollars.   Well,  there  was  one  other  difference:  to 
go  to  medical  school,  I  had  to  have  Shakespeare,  zoology,  and 
embryology  as  prerequisites.   I  said,  "Okay.   I'll  get  the 
money,  so  I'll  go  on  working  in  gardening  and  chemistry—do 
whatever  I  can—and  I'll  make  up  these  courses,  get  them  done 
within  the  next  year,  and  then  I'll  apply."  So  I  only  applied 
to  one  school- -UCSF.   I  didn't  have  the  money  or  the  vision  or 
the  interest  in  going  elsewhere.   My  wife  still  wasn't  done 
with  college  here  in  Berkeley,  anyway.   So,  that's  what  I  did, 
and  I  got  in  as  soon  as  I  applied  in  1938. 

Crawford:   Did  you  apply  other  places  besides  UCSF? 

Blum:      No.   There  was  no  point  to  applying  elsewhere  to  medical 
school.   I  didn't  have  any  money.   I  had  about  a  thousand 
dollars  in  the  bank  saved  up  from  all  the  odd  jobs.   With 
tuition  being  rather  cheap  at  UCSF--it  was  seventy-five  dollars 
a  semester  for  two  semesters  a  year—you  knew  that  you  could 
get  by.   My  wife  was  still  in  school,  she  was  still  an 
undergrad,  supported  herself.   So  we  knew  we  could  get  by  for  a 
year.   UCSF  made  you  sign  a  statement  that  said  you  had  at 
least  three  thousand  dollars  available.   I  didn't,  so  I  had  to 
go  get  my  father's  signature.   He  was  still  up  in  the  Napa 
Valley,  and  I  got  his  signature.   He  didn't  much  give  a  damn 
one  way  or  another.   He  thought  I  was  crazy  but  he  felt  under 
no  promise  to  help  me,  nor  did  he  have  any  means  even  if  he 
wanted  to. 

Crawford:   He  didn't  think  much  of  that  choice? 

Blum:      No,  and  I'd  never  thought  of  medical  school  before. 


57 


III   UNIVERSITY  OF  CALIFORNIA  MEDICAL  SCHOOL:  1938-1942 


Happy  Jack:  Starting  Medical  School  and  Finding  Housing 


Blum:       It  took  me  a  year  to  do  the  extra  requirements,  but  that's  how 
I  had  the  time  to  earn  the  money  to  go  to  school.   That  was  not 
a  struggle.   I  was  young,  so  I  had  those  extra  years.   I  made  a 
lot  of  nice  friends  taking  these  courses.   Some  of  them  are 
still  around  here  in  the  sciences. 

Crawford:   People  are  still  in  those  departments? 
Blum:      Oh,  yes. 

Our  first  day  in  medical  school  was  in  anatomy.   We 
received  a  sixty-pound  oak  box  made  in  San  Quentin  that 
contained  a  five-pound  human  skeleton.   This  had  to  be  taken 
home  as  it  could  not  remain  on  the  laboratory  premises.   I  got 
a  ride  for  me  and  my  skeleton,  but  a  block  from  campus  there 
was  our  tiny  classmate  Bertha  bogged  down  with  about  a  mile 
more  to  go  with  her  box.   We  got  her  home,  but  I'm  still  not 
free  of  that  memory  of  my  medical  school's  concern  for  the 
welfare  of  its  students. 

In  the  next  twenty-four  hours,  we  had  chosen  partners,  four 
of  us  to  a  cadaver.   In  spite  of  all  that  one  hears  about  the 
trauma  to  medical  students  that  comes  from  dismembering  a  dead 
person,  our  trauma  came  suddenly  and  repeatedly  from  the 
faculty  dismembering  us.   By  noon  of  that  second  day,  we  had 
our  first  taste  of  good  teaching  relationships.   Our 
instructor,  who  was  best  known  as  "Happy  Jack,"  summoned  us  to 
the  front  of  the  lab,  sitting  on  our  stools,  and  began  to  quiz 
us  on  our  assignment  that  we  had  more  or  less  begun. 

As  he  settled  himself  to  the  joys  of  intellectual  sadism, 
he  looked  around  and  saw  one  of  us  who  had  facial  paralysis  and 
a  wry  paralytic  smirk  as  a  result  of  a  birth  injury.   This  so 


58 


demoralized  Happy  Jack,  who  didn't  believe  that  anyone  should 
be  smirking  as  he  was  about  to  lash  us  into  shape,  that  he 
snarled,  "Wipe  that  stupid  smile  off  your  face  when  I'm 
lecturing." 

Our  partner  in  medical  school  couldn't  wipe  his  paralysis 
off;  he  was  embarrassed  at  being  picked  on  for  his  disability, 
and  as  I  got  to  know  him  for  what  a  kindly  person  he  was ,  his 
embarrassment  was  probably  mostly  for  our  instructor,  who  was 
such  a  pitiful  physician  that  he  couldn't  even  recognize  a 
common  birth  injury.   Happy  Jack  lived  up  to  his  nickname  and 
committed  suicide  a  year  later. 

Our  next  hurdle  came  in  histology  next  afternoon.   The  man 
in  charge  was  competent  but  apparently  somewhat  resentful  of 
only  being  number  two  in  the  hierarchy.   He  made  us  feel  right 
at  home  by  disapproving  of  most  of  the  microscopes  which  we  had 
to  and  did  purchase  on  our  own.   Since  they  couldn't  be 
inspected  prior  to  beginning  classes,  it  was  a  bit 
disheartening  to  find  out  that  we  couldn't  proceed  to  do  the 
course  work,  which  was  90  percent  microscopy.   But  few  of  us 
could  afford  another  scope.   Mine  was  an  unused  although 
secondhand  one  that  did  a  good  job.   An  earlier  admittee  had 
gotten  about  this  far  on  his  medical  career,  thought  better  of 
it,  or  was  plain  intimidated,  and  sold  his  investment  in 
medical  school.   No  one  offered  to  help  us  so  all  of  us  fiddled 
around,  cleaned  our  scopes,  and  went  on  with  our  assignments 
with  some  trepidation,  but  the  instructors  looked  through  our 
scopes  after  all,  and  we  all  survived.   These  events  made  for  a 
most  enjoyable  entry  into  a  medical  career,  one  not  to  be 
forgotten,  although  often  suppressed  as  each  of  us  came  to 
enjoy  the  benefits  of  being  an  M.D. 

I  had  a  most  disquieting  few  minutes  about  two  nights  after 
we  had  taken  our  finals.   Marian  and  I  were  to  be  married  the 
day  before  Christmas  and  her  sister  came  to  stay  with  her  for  a 
few  days  before  the  marriage  in  our  newly  rented  apartment. 
Marian's  sister  was  an  old  friend  of  our  professor  of  histology 
and  had  arranged  to  meet  her  at  our  apartment,  unbeknownst  to 
me.   I  got  there  from  work  and  was  astounded  to  see  one  of  my 
key  professors  there.   This  professor  was  presumably  a  very 
stern  woman,  not  unfriendly,  but  all  business.   I  wondered, 
"What  could  she  be  doing  at  our  apartment,  what  could  be 
wrong?"  As  she  learned  of  my  impending  marriage  she  said,  "I 
have  a  present  for  you.   You're  sharing  first  place  in  your 
class  in  medical  school." 

Two  days  later  we  took  the  streetcar  to  the  Hall  of  Justice 
and  had  a  most  unromantic  ceremony.   Then  we  went  to  Richmond 


59 


to  see  Bill  Mills,  his  wife,  and  new  baby.   To  finish  the 
wedding  day  off,  Marian's  father  took  us  to  dinner. 

Marian  still  begrudges  the  streetcar  and  the  ceremony  at 
the  Hall  of  Justice. 


Crawford:   The  Hall  of  Justice  in  San  Francisco? 

Blum:      No,  Oakland.   We  still  lived  on  this  side.   The  first  year  of 

medical  school  was  in  Berkeley.   In  the  Life  Sciences  Building. 
We  did  anatomy,  histology,  biochemistry,  all  those  courses 
here.   The  first  year  was  moved  in  later  years  to  San 
Francisco.   So  that  was  a  good  start,  and  there  were  no  regrets 
at  that  point,  except  my  wife's  having  to  take  the  streetcar  to 
get  married. 


Chauncey  Leake  and  Pharmacology 


Blum:      In  the  course  of  those  first  two  years  in  medical  school,  we 
also  had  to  take  a  course  called  pharmacology,  taught  by  this 
great  man,  Leake,  who  had  told  me  I'd  probably  never  make  it. 

I  took  pharmacology,  and  I'll  never  forget  this  professor. 
He  was  a  real  blow-hard,  a  good  storyteller.   The  first  thing 
he  told  us  was  to  go  out  and  buy  a  book  that  he  had  written 
with  a  newspaper  man  called  Medicine:  Magic  in  a  Bottle.   This 
was  our  textbook  in  pharmacology.   Well,  it  was  a  fun  book. 
But,  at  the  same  time,  the  most  beautiful  of  all  medical 
textbooks  came  on  the  market,  Goodman  and  Oilman  on 
pharmacology,  still  a  classic,  how  one  should  really  write 
textbooks.   I  heard  about  it  from  somebody  and  went  down  and 
bought  it.   In  those  days,  it  cost  around  twenty  dollars.   That 
is  like  a  hundred  dollars  or  more  now.   It  was  a  joy  to  study, 
it  was  so  good.   It  was  a  whole  bible  of  medicine  in  itself, 
built  around  how  each  drug  affected  human  metabolism. 

So  I  got  a  little  worried.   This  man's  giving  us  a  two-bit 
paperback  to  read  because  it's  a  best-seller--as  I  said,  he 
also  turns  out  to  be  one  of  the  authors  of  this  thing- -and  to 
overlook  a  classic. 

I'll  never  forget  the  first  day  we  were  going  to  do  animal 
experiments  with  drugs.   We  were  going  to  do  it  on  rabbits.   We 
were  to  put  some  drops  in  their  eyes,  some  fairly  innocuous 
substance.   The  professor  has  this  big,  tall,  blond  lady 
assistant,  whom  I  remembered  from  Berkeley.   They  are 


Crawford: 
Blum: 


60 


illustrating  how  you  keep  the  rabbit  happy, 
animal  abuse  in  this  class. 


You  don ' t  want  any 


While  he's  yakking,  and  petting  the  animal,  it  is  getting 
more  and  more  nervous  and  agitated.   Really,  it  was  kind  of 
pitiful.   Here's  a  class  of  sixty-five,  pretty  critical 
characters  who  already  sense  a  debacle.   Sure  enough,  he  said, 
"Now  we've  got  to  put  the  animal  on  its  back."  He  tried,  and 
the  rabbit  was  all  over  the  place.  They  have  to  be  tied  down, 
you  know,  strapped  down  on  a  little  platform.   Finally,  he 
yells,  "Grab  the  bastard!"  And  they  tie  him  down.   [laughter] 
This  is  after  all  the  garbage  about  how  to  be  gentle  and  take 
good  care  of  an  animal.   That's  Chauncey  at  his  best. 

I  worked  in  this  lab  with  three  other  students.   One 
fellow,  Aaron  Davis,  who  became  a  family  practitioner  out  here 
in  the  East  Bay  for  many  years,  was  a  lovely  man  who  had  a 
touch  with  animals.   He  got  the  animal  practically  mesmerized; 
and  he  didn't  turn  the  animal  onto  its  back,  but  put  the  ropes 
over  the  animals  ears—didn't  tie  them  at  all,  just  to  keep  the 
animal  comfortable.   He  put  the  drop  into  the  animal's  eyes, 
and  we  can  see  the  pupils  dilate,  and  this  and  that.   It's  just 
a  lovely  way  of  doing  an  experiment  with  a  happy  rabbit.   But 
the  dumb  blonde  came  by,  and  she  took  one  look  and  screamed, 
"That's  not  the  way  to  do  it.   You  can't  have  the  ropes  over 
their  ears."  All  of  a  sudden  our  table  is  a  grim  spectacle. 
Chauncey  rushes  over  to  us,  and  after  their  fiasco—they 
couldn't  even  get  the  rabbit  turned  over—they  start  picking  on 
us  for  bad  animal  handling.   Well,  that  was  the  end  of  my 
notions  of  ever  going  into  pharmacology  as  long  as  Chauncey  was 
around.   Just  a  bunch  of  dunces;  and  it's  an  important  field. 
It's  a  huge  field. 

Why  was  he  in  the  position  that  he  was? 

Well,  a  great  talker.   He  went  on  to  Texas  to  be  dean  of  a 
medical  school  there. 


Crawford:   What  was  Chauncey 's  whole  name? 
Blum:      Leake. 

Being  a  Pain  in  the  Neck  in  Pathology  in  Our  Second  Year 


Blum:      In  our  second  year  we  began  our  pathology.   It  was  my  favorite 
course  because  it  not  only  described  but  explained  the 


61 


abnormalities  underlying  and  subsequently  resulting  from  each 
disease.   We  studied  organs  and  tissues  both  in  the  gross  and 
under  the  microscope  as  part  of  understanding  what  was  going  on 
normally  and  then  what  was  going  on  in  the  disease  process. 

Once  a  week  we  had  a  fifteen-minute  quiz,  each  of  us 
getting  a  comparable  slide  from  some  part  of  the  body  to 
determine  what  disease  process  was  going  on. 

I  flunked  the  first  quiz  by  putting  down  inflammation  and 
an  organized  clot  in  a  vein.   The  correct  answer  was 
hemorrhoid,  which,  of  course,  is  exactly  what  I  described.   The 
rest  of  the  class  all  had  the  correct  one-word  answer  and  got 
an  A.   A  little  sleuthing  revealed  that  each  fraternity  house 
had  a  box  of  all  the  slides  to  be  used  in  the  quizzes,  along 
with  the  correct  answer.   Since  the  exams  were  the  same  each 
year  they  knew  what  to  call  each  slide.   Next  week  was  a 
repeat.   I  got  a  flunk  for  describing  a  skin  break  when 
everyone  else  knew  it  was  a  "stab  wound."   I  was  mad  and  went 
to  the  professor,  who  seemed  shocked  by  what  was  going  on. 
From  then  on  we  got  new  fresh  slides.   I  got  A's  from  then  on 
and  most  of  the  class  just  got  by. 

Several  of  my  classmates  berated  me  for  making  life  tough 
for  them—why  hadn't  I  come  to  them  and  they  would  have  shared 
the  slide  boxes  and  the  answers? 

I  was  no  more  but  no  less  of  a  loner  than  before.   I  had 
not  joined  the  Jewish  fraternity  under  some  pressure.   One  non- 
Jewish  frat  had  indicated  a  willingness  to  have  me  as  a  member. 
However,  the  frats  had  little  to  offer  a  married  student  since 
their  main  function  was  to  provide  reasonable  board  and  room 
arrangements  for  single  men.   True,  belonging  to  a  frat  was  the 
proper  thing  to  do  and  the  frats  were  the  center  of  what  little 
social  life  there  was  in  medical  school. 


Blum:      Another  story  from  medical  school,  sophomore  year,  practicing 
physical  diagnosis  on  patients  at  the  Laguna  Honda  Nursing 
Home.   We  passed  a  patient  out  in  the  hall  and  she  was  purple 
in  the  face.   She  was  puffing  and  breathing  hard  and  looked 
like  the  end  was  near.   Our  instructor  pulled  us  aside  and 
said,  "What  do  you  think  that  is?"  I  said,  "Lobar  pneumonia." 
He  looked  a  little  grim,  like,  "These  students  are  really 
ignorant."   He  was  a  nice  person,  and  he  didn't  berate  me  for 
it,  but  it  was  clear  he  didn't  think  much  of  my  diagnosis. 
This  other  kid,  whom  we  called  the  Vermin--it  rhymed  with  his 
real  name  —  took  a  chance  and  said  this  was  Kussmaul  breathing: 


62 


Crawford: 
Blum: 


deep,  diabetic,  acidotic  breathing.   We  were  sophomores  and 
didn't  know  very  much,  and  the  instructor  looked  pleased,  like, 
"Hey,  we've  got  a  genius  in  this  class." 

So  I  got  kind  of  upset  about  my  poor  showing.   When  the  day 
was  over,  I  wandered  back  to  the  nursing  station  and  pulled 
this  lady's  chart.   She  had  lobar  pneumonia.   It  was  so  typical 
one  didn't  need  experience  to  diagnose  it.   The  instructor  was 
a  nice  person,  one  you  could  talk  to.   Years  later  when  I  got 
to  know  him  I  asked,  "Jack,  how  in  the  world  could  you  ever 
think  that  was  Kussmaul  breathing?   I  verified  from  the  records 
that  the  patient  had  a  typical  case  of  lobar  pneumonia."  The 
response  was,  "They  never  put  lobar  pneumonia  cases  out  in  the 
hall."   [laughs] 

That's  a  great  story. 

That's  how  you  learn  medicine. 


Housing  During  Medical  School 


Blum:       In  the  third  year  of  medical  school  at  UCSF,  we  were  at  the  San 
Francisco  General  [then  County]  Hospital.   We  got  an  apartment 
at  24th  and  York.   The  landlords  were  born  in  Italy  and  had 
lived  in  Argentina  and  had  a  son  about  our  age  named  Tony,  who 
was  a  golden  gloves  champ  who  ended  up  getting  a  masters  in 
Italian  studies  here  at  Cal. 

They  were  lovely  people  named  Calonico  and  were  very  good 
to  us  —  they  had  bought  us  some  furniture  for  this  apartment,  as 
we  had  none.  We  then  moved  across  the  street  from  UCSF  for  my 
last  year  and  then  we  were  gone  for  years  and  years ,  but  at  the 
end  of  the  war  when  I  came  back  to  Stanford  we  went  to  see  the 
Calonicos.   They  still  had  the  four  apartments,  lived  in  one  of 
them  and  had  the  downstairs  grocery  store,  which  opened  at  six 
in  the  morning  and  closed  anywhere  from  eight  o'clock  on.   This 
was  seven  days  a  week.   First  a  little  kid  would  come  in  and 
get  bread,  someone  else  come  in  for  this  and  that,  and  this 
went  on  all  day  long.   They  knew  everybody  in  the  neighborhood. 
There  were  Italians,  Germans,  Irish,  Spanish,  a  basic  mix  for 
this  Mission  District  area. 

It  turned  out  the  parents  had  never  taken  a  vacation 
together.   Sometimes  Papa  could  go  away,  sometimes  Mama  could, 
and  Tony  was  in  the  middle  holding  onto  things  too.   Well,  we 


63 


weren't  settled  yet,  so  we  offered  to  run  the  grocery  store  for 
them  so  they  could  take  a  long  weekend  vacation. 

They  said  Tony  could  show  us  how.   They  trusted  us,  and  we 
went  down  at  six  in  the  morning  to  buy  produce—the  produce 
center  was  on  the  north  side  of  Market  then.   We  would  open  up 
in  the  morning  and  come  dinner  time  we  would  eat  all  the  stuff 
that  was  getting  too  ripe—you've  never  seen  such  gargantuan 
desserts  of  figs,  peaches,  melons,  bananas  and  whipping  cream! 
[laughter] 

So  the  folks  got  away  to  Yosemite,  and  in  the  course  of 
this  I  delivered  groceries--! 'd  put  an  orange  crate  on  my 
shoulder  and  take  the  groceries  around  the  neighborhood.   I 
started  meeting  residents  who  were  quite  shook  up.   The 
customers  whom  we  knew  from  when  we  lived  upstairs  would  say: 
"Doctor!   What  are  you  doing  here?  Did  you  buy  the  store?" 
[laughter]   They  knew  I  had  been  in  medical  school.   Well,  I 
thought  that  was  kind  of  fun,  the  neighbors  remembering  us, 
five  years  later,  and  we  remembering  the  neighbors. 

Tony  lives  in  our  neighborhood  in  Berkeley  now  and  has 
raised  five  kids;  in  fact,  his  folks  came  here  ultimately  and 
we  visited  with  them  after  they  retired.   They  wanted  to  be 
with  the  kids. 

And  then  on  Parnassus--!  had  taken  part  of  my  senior  year 
and  become  a  substitute  intern,  primarily,  as  I  said,  to  avoid 
unpleasant  services.   My  substitute  internship  was  in  surgery, 
not  that  I  thought  I'd  be  a  surgeon.   During  this  time  we  lived 
in  an  apartment  house  across  the  street  from  the  hospital,  and 
I  remember  the  first  couple  of  nights  I  was  away--I  often  was 
away  all  night--and  I  came  home  and  Marian  said,  "What's  going 
on  over  there—they  are  killing  people."  Turned  out  we  lived 
across  the  street  from  the  obstetrics  unit  and  she  was  hearing 
the  delivery  room  shrieks.   [laughter]   We  were  in  that 
building  when  the  Japanese  bombed  Hawaii  and  we  knew  we'd  soon 
be  in  the  war.   One  day  all  our  Japanese  classmates 
disappeared.   I  don't  think  we  felt  any  fear,  but  to  have  these 
people  disappear  right  out  of  medical  school—one  of  them  I  was 
close  to,  a  woman  surgeon  who  lives  in  Palo  Alto  now— Bertha 
Akimoto.   She  was  sent  off  to  camp  and  then  like  other  women 
was  freed  to  live  elsewhere.   She  ended  up  under  my  aunt's  wing 
at  medical  school,  Mt.  Sinai  in  New  York,  and  became  a  surgeon. 
It  was  a  horrible  thing  and  the  real  point  is  that  nobody 
objected.   I  kept  thinking  that  was  the  way  Germans  must  have 
felt  about  Hitler's  increasing  viciousness. 


Crawford:   No  sense  of  outrage. 


64 


Blum:      The  concentration  camps  were  in  part  the  handiwork  of  our  good 
governor,  who  became  such  a  great  man  as  a  Supreme  Court 
justice.   I  told  you  we  went  to  visit  the  Jimmy  Carter  Library 
in  Atlanta,  and  the  first  section  there  is  devoted  to  the 
Japanese  incarceration.   We  were  on  a  tour  and  there  were  some 
California  Japanese  people  with  us  and  we  were  just  curious  to 
know  how  they  felt  about  it,  and  they  said  it  was  just  was  one 
of  those  things  that  happened.   I  was  depressed  about  that 
because  most  of  the  Japanese  I  know  didn't  feel  that  way  about 
it.   My  associate,  Yoshiye  Togasaki,  wasn't  very  happy  about 
it—lost  everything  to  boot. 


Obstetrics  at  San  Francisco  General  ## 


Blum:      My  first  significant  participation  in  patient  care  came  at  the 
beginning  of  my  third  year  in  1941  at  the  San  Francisco  General 
Hospital.   It  was  in  obstetrics  and  for  our  debut  we  were  put 
in  a  beautiful  new  delivery  suite,  lots  of  glass  for  the  family 
to  look  in,  gorgeous  green  everything,  including  the  lovely 
slick  new  tile  floor.   My  partner  was  an  old  friend  from 
chemistry  days.   We  students  were  to  take  the  delivery  as  far 
as  we  could,  and  had  for  guidance  probably  the  best  obstetrics 
resident  anyone  had  ever  seen,  Earl  Marsh,  a  majestic, 
charismatic  person  as  well  as  being  an  acknowledged  superlative 
obstetrician. 

He  was  one  of  the  few  higher-ups  that  we  all  trusted,  and 
we  knew  that  he  was  genuinely  interested  and  wanted  us  to  learn 
how  to  do  things  and  to  succeed.  Although  women  have  by 
themselves  been  delivering  babies  forever  in  an  apparently 
straightforward  way,  this  is  not  how  our  first  case  appeared  to 
us,  and  we  were  apprehensive.   Our  patient  was  a  beautiful 
young  lady  having  her  first  pregnancy.   She  was  also  deaf  and 
essentially  dumb.   None  of  her  three  doctors,  if  we  two 
students  can  be  pretentious,  could  do  sign  language. 
Translators  of  any  kind  were  unknown  in  those  days.   So  Bob  and 
I  made  a  series  of  one-foot  by  two-foot  signs,  the  first 
saying,  "Take  a  deep  breath,"  the  second,  "Hold  it  and  bear 
down,"  the  third  said,  "Let  it  out,"  and  the  fourth  said, 
"Relax."   I  think  there  was  one  other.   We  couldn't  explain  any 
of  this  to  our  patient,  who  was  going  into  active  labor,  but 
she  caught  on  pronto  and  we  were  underway. 

For  some  reason,  perhaps  out  of  deviltry,  or  a  feeling  that 
Bob  and  I  weren't  getting  sufficient  exercise,  our  mentor,  Earl 
Marsh,  had  the  lady  put  one  foot  on  one  of  Bob's  shoulders  and 


65 


one  on  mine  instead  of  into  the  usual  stirrups  on  the  delivery 
table  by  means  of  which  the  deliverers  braced  themselves.   We 
cleansed  her  perineum,  and  in  the  process  made  this  beautiful 
new  green  tile  floor  quite  slippery.   As  we  peeled  off  the 
first  sign  saying  "Deep  breath"  and  then  the  second  saying 
"Hold  it  and  bear  down,"  this  healthy  young  woman  leaned  into 
the  process  and  Bob  and  I  went  scooting  across  the  floor  and  up 
against  the  back  glass  wall,  no  help  to  our  patient.   We  went 
back,  put  towels  on  the  floor,  and  went  sailing  again.   Nothing 
helped  and  she  kept  us  skidding  helplessly  until  we  connected 
her  with  the  stirrups.   Then  her  labor  pains  got  powerful  and 
Bob  and  I  got  the  signs  all  mixed  up  and  all  three  of  her 
doctors  got  hysterical.   She  was  clearly  in  no  danger  and 
undoubtedly  would  have  done  better  if  three  male  clowns  weren't 
laughing  uncontrollably. 

I  can't  forget  her  cute  and  distressed  smile  as  she 
enunciated,  "What's  so  funny?"  We  sobered  up  magically  and  I 
swore  off  obstetrics  for  life.   Bob  became  an  ophthalmologist 
and  I  an  internist-preventive  medicine  specialist.   Earl  Marsh 
continued  as  the  superlative  obstetrician,  hopefully  avoiding 
neophyte  shoulders  and  slippery  floors.   The  new  baby  was  a 
great  success. 


Crawford:   Well,  would  you  like  to  venture  in  to  what  happened  to  Vermin 
in  his  career? 


Blum:      It  was  desperate.   He  went  into  a  specialty  practice  that  I 
knew  in  the  Bay  Area,  and  they  had  to  get  rid  of  him  in  a 
matter  of  months. 

But  his  father  was  a  professor  at  UCSF.  So  it  hadn't  been 
all  accidental;  there  was  some  leeway  for  that.  But  he  was  too 
much  for  a  practice  —  or  should  I  say,  too  little. 

Crawford:   It  was  connections. 

Blum:      Yes.   Apparently,  they  must  have  told  the  practice  that  he  was 
good.   To  go  to  that  practice,  you  had  to  be  good.   Such 
episodes  were  also  part  of  the  joys  of  medical  school. 

I  remember  I  couldn't  stand  the  chief  of  neurosurgery  when 
I  was  in  medical  school;  he  was  also  the  president  of  the  board 
of  regents  of  the  University  of  California,  and  the  dean  of  the 
medical  school,  and  was  a  horrible  person. 

Crawford:   Do  you  want  to  say  who? 


66 


Blum:      Howard  Naffziger.   He  was  very  famous  in  his  field.   I  remember 
when  we  were  seniors,  early  in  the  semester,  being  in 
orthopedics  clinic  along  with  a  girl  classmate.   We  were  seeing 
patients,  and  somebody  came  up  to  her  and  said,  "Naffziger 
wants  to  see  you."   She  said  to  him,  "Well,  please  tell  him 
that  he  knows  where  I  am.   If  he  wants  to  see  me,  he  can  see 
me."  That  was  pretty  wild.   Naffziger  was  a  god.   By  four 
o'clock  that  afternoon,  she  was  locked  up  for  psychiatric 
observation,  never  came  back  to  medical  school. 

Crawford:   Locked  up  for  observation?  Because  she  said  that? 

Blum:      Yes.   I  don't  think  she  was  mentally  ill.   I  think  she  was  so 

frustrated,  so  sick  of  the  old  bastard.   She  never  came  back  to 
medicine.   She  changed  her  career. 

He  was  that  authoritarian.   I  could  tell  at  that  moment  how 
I  was  going  to  relate  to  him  when  I  came  on  his  service  as  a 
senior.   I  knew  I'd  never  survive.   One  could  switch  out  of 
fourth  year  services  into  an  internship  if  an  intern  got  sick, 
and  one  of  the  surgical  interns  did  get  tuberculosis  when  I  was 
a  senior.   I  raised  my  hand  as  fast  as  the  poor  guy  departed  to 
go  into  a  hospital  for  six  months  treatment.   So  I  became  a 
surgical  intern.   That  was  wonderful,  and  I  managed  to  stay  out 
of  neurosurgery  because  I  was  volunteering  service  by  service. 
I  never  did  neurosurgery  and  never  had  to  deal  with  Naffziger. 

I  had  some  other  interesting  intern  experiences  at  UCSF. 
The  head  of  surgery  at  that  time  was  kind  of  a  farmerish,  plain 
person,  and  very  pleasant  to  me,  pleasant  to  his  patients.   I 
worked  up  a  patient  for  him.   He  took  out  the  patient's 
stomach—most  of  his  stomach—and  I  did  all  the  scut  work.   I 
tested,  did  this,  and  did  that,  and  did  an  extensive  history 
and  physical  exam.   Then  I  watched  the  surgery.   We  made  rounds 
on  him  several  times  a  day  and  I  kept  close  contact  with  him. 
When  the  chief  of  surgery  said,  "You  can  go  home.   You're  fine, 
and  we  won't  see  you  for  such  and  such  a  time,"  the  patient 
said,  "I  don't  want  to  go  home  until  I  see  my  doctor."  He  was 
talking  about  me.   The  surgeon  just  about  busted  a  gut.   Not 
with  happiness,  either.   He  was  a  very  fine  surgeon;  but  this 
was  too  much  for  him.   [laughs] 

I  never  held  it  against  him.  In  fact,  later  on,  he  did 
some  surgery  on  my  wife,  and  turned  out  to  be  a  pretty  crude 
guy,  as  I  should  have  expected. 

Crawford:   Pretty  crude? 


67 


Blum:      Yes.   She  said  she  didn't  want  a  spinal,  and  he  said,  "Fine, 
you  don't  have  to  have  a  spinal."  And  lo  and  behold,  when  it 
came  time  for  surgery,  she  got  a  spinal,  willy  nilly.   She 
objected—that  was  tough--just  shut  up  and  take  it,  it's  over. 
I  don't  go  for  that  sort  of  doctor  approach.   So,  he  wasn't 
such  a  sweet  farmer  type  after  all. 

Medical  school  was  quite  an  education  up  and  beyond 
technical  skills.   When  we  graduated,  we  put  on  a  play  and 
invited  the  faculty  to  attend.   Of  course,  the  play  was  always 
a  takeoff  on  our  education,  and  there  was  plenty  to  take  off 
on:  a  roast.   So  I  got  the  task,  thanks  to  my  grade  point 
standing,  to  invite  a  couple  of  the  professors  that  we  had 
never  seen  in  four  years  of  medical  school. 

One  was  the  chief  of  obstetrics.   He  was  kind  of  a  sweet, 
old  guy.   From  what  we  heard  he  used  to  drive  everybody  nuts  in 
surgery  because  he  always  listened  to  Jack  Benny  on  the  radio. 
And  all  during  the  surgery,  he'd  be  telling  all  the  wonders  of 
Jack  Benny  the  night  before.   I  caught  him  just  before  he  went 
into  surgery,  and  he  was  pleasant  about  it--a  good  man,  an  old 
man.   I  said  we  wanted  him,  particularly,  to  come  as  our  guest 
--we  were  roasting  him  good—to  our  senior  party.   So  he  said, 
"What  do  you  want  me  for?   I'm  an  old  man."   I  said,  "I  don't 
know  about  everybody  in  the  class,  but  I've  never  seen  you 
before,  and  I'm  graduating;  and  you're  chief  of  obstetrics,  and 
we  thought  it  would  be  nice  if  we  could  see  you."  That  was  the 
kind  of  medical  school  it  was. 

Crawford:   You  just  never  got  posted  to  his  service? 

Blum:      Only  a  handful  of  students  ever  saw  him.   He  was  making  a 

fortune.   He  wasn't  there  to  teach  medical  students.   He  taught 
residents,  to  be  sure.   He  said,  "Well,  that's  a  thought."  He 
said,  "I'll  come."   [laughs] 

Crawford:   You  got  him? 

Blum:      Got  him.   But  he  never  did  come.   Then  I  tried  to  get  the  chief 
of  urology,  who  was  really  a  world-famous  surgeon,  one  of  the 
truly  famous  professors  at  UCSF,  a  Hopkins  man.   I  came  down  to 
his  office  early  one  morning  before  surgery  would  ever  start- 
he  spent  all  day  long  in  surgery—and  his  secretary  said,  "He 
never  sees  students."   I  said,  "Yes,  but  I  want  to  invite  him 
to  the  senior  party,  and  so  I've  got  to  talk  to  him."   She  was 
a  nice  enough  lady.   I  knew  her- -a  nurse- -she  was  the  head  of 
his  pool  of  people.   She  said,  "I'll  get  you  in  here  some 
morning  between  seven  and  seven-thirty."  Well,  he  threw  me  out 
when  I  accosted  him!   He  wasn't  dealing  with  students.   No  way. 


68 


So  he  never  did  get  invited,  but  that  was  not  atypical  of 
senior  faculty  at  UCSF  in  those  days. 

Crawford:   That's  enough  to  take  you  away  from  medicine,  right  there, 
isn't  it? 

Blum:      Yes.   One  gets  a  funny  feeling  that  such  professors  weren't  all 
that  good  about  patients  either.   There  were  some  nice  people, 
in  fact  there  were  wonderful  people,  such  as  the  pediatrician 
Mary  Olney  in  charge  of  the  diabetes  service. 


Crawford:   Was  there  a  mentor  in  medical  school? 

Blum:      We  had  some  faculty  who  were  decent  folks,  all  of  whom—the 

decent  ones—were  friendly.   I  got  involved  in  a  few  things.   1 
brought  the  American  Medical  Students  Association  to  UCSF  when 
I  was  a  junior.   It  involved  my  going  to  a  big  meeting  in 
Boston,  and  then  coming  back  with  the  info.   Everybody  joined 
up,  all  the  medical  students.   The  membership  was  like  twenty- 
five  cents.   But  it  was  thought  to  be  a  Communist  front  by  the 
faculty.   We  knew  that  the  school  was  scared  to  death  of 
horrible  things  like  that.   AMSA,  now,  is  a  big  deal.   Many  of 
the  students  here  at  the  JMP  [Joint  Medical  Program]  are 
officers  in  AMSA  these  days. 

Well,  I  was  the  first  one  from  the  West,  so  I  was  quite  a 
hero  back  there  in  Boston;  but  when  I  brought  it  back,  it  was 
very  clear  I  was  going  to  have  trouble.   There  was  talk  about 
the  Communist  menace  and  all  that  sort  of  thing.   One  of  the 
first  things  we  did  was  to  ask  for  lockers  for  the  students, 
and  a  few  other  minor  things.   The  reason  the  lockers  were  in 
my  mind,  I  had  a  classmate  who  had  rheumatoid  arthritis,  and  he 
had  to  carry  his  microscope  up  the  hill  to  classes  from  where 
he  lived,  and  he  was  on  crutches.   He  died  about  our  junior 
year,  about  the  time  that  I  brought  AMSA  to  UCSF,  and  I  asked 
for  lockers.   There  was  no  place  for  him  to  store  a  microscope. 
Nobody  gave  a  damn  about  a  medical  student.   It  was  horrible. 

Crawford:   That  kind  of  activism  must  have  been  uncommon? 

Blum:  Yes,  it  was,  in  those  days.  The  reason  I  did  it  and  the  reason 
everybody  said,  "Go  ahead,  go  ahead,"  was  that  I  was  number-one 
scholar  of  my  class. 

Crawford:   You  could  get  away  with  it? 


69 


Blum:      Yes,  and  wasn't  going  to  get  wiped  out  academically.   When  I 
did  get  back,  I  immediately  lost  my  scholarship.   Within  a 
matter  of  hours,  one  of  the  nice  professors  —  a  really  lovely 
fellow,  became  quite  a  big  wheel  elsewhere  —  came  up  to  me  and 
said,  "You've  lost  your  scholarship.   I  don't  know  if  you  know 
about  it."  He  said,  "Professor  Goldman,  who  is  chairman  of  the 
committee,  saw  to  it."  Well,  Goldman  happens  to  be  our  Senator 
Feinstein's  father.   He  was  a  great  surgeon  and  probably  our 
best  teacher,  but  he  was  a  cheap  son  of  a  bitch,  too. 

Crawford:   He  didn't  want  any  trouble. 

Blum:      Correct.   He  wasn't  the  dean  or  anything,  he  was  just  chief  of 
surgery  at  that  time.   So  I  started  getting  all  F's  in  surgery. 
It  didn't  really  knock  my  standing  all  that  much  because  I'd 
built  up  too  much  of  a  lead  in  grade  points.   He  stopped  me  in 
the  hall  a  couple  of  days  later  and  said,  "Did  you  get  your 
scholarship?"  The  other  man  tells  me  that  this  man  has  wiped 
me  out,  and  he  stops  me  to  see  if  I  got  it—a  neat  person. 

Well,  we  didn't  expect  to  get  scholarships  when  we  went 
through  school.   My  wife  and  I  always  said  it  doesn't  make  any 
difference.   We're  not  knuckling  under  to  anybody.   This  is  the 
way  it  is.   But  this  was  another  reason  to  push  people  like  me 
towards  public  health. 

Crawford:   That  must  have  been  a  horrific  experience. 

Blum:      The  loss  of  a  scholarship  was  just  a  wake-up  call. 


Treating  the  Poor  and  Thoughts  of  a  Career  in  Public  Health 


Blum:      My  wife  and  I  both  got  over  any  notions  about  my  being  a 

pharmacologist,  and  I  continued  on  through  medical  school. 
Ethics  had  an  odd  way  of  popping  up  in  my  life.   One  of  the  two 
lectures  we  had  on  ethics,  for  example,  was  by  a  Catholic 
gynecologist.   When  I  was  an  intern  later  on,  he  was  the  head 
of  the  service  that  I  was  on,  OB-GYN  at  Franklin  Hospital  (now 
Davies).   I  worked  up  one  of  his  patients.   I  couldn't  figure 
out  why  we  were  doing  a  hysterectomy.   It  was  a  Catholic  lady, 
in  her  late  thirties.   I  took  a  history— nothing.   What  are  we 
doing  taking  out  her  uterus?  That  was  not  a  Catholic  hospital, 
but  it  was  a  Catholic  patient  and  a  Catholic  doctor. 

When  we  got  to  surgery  and  she  was  under  the  anesthetic, 
and  we  were  happily  cutting  away,  I  said  to  the  doctor,  "I 


70 


never  could  figure  out  why  we're  doing  this  when  I  worked  her 
up  for  surgery."   "Oh,"  he  says,  "Doctor,  prophylaxis. 
Prophylaxis."  And  I  got  a  funny  feeling  about  who  was  teaching 
ethics  and  what  ethics  were.  Was  he  talking  about  making 
money?  Was  he  talking  about  her  avoiding  having  any  more  kids? 
It  turns  out,  of  course,  that  is  a  not  uncommon  occurrence  in 
the  Catholic  world,  and  also  in  the  Mormon  world  where  women 
don't  feel  able  to  use  contraception. 

Crawford:   Among  Mormons? 

Blum:      Yes,  because  they  can't  stop  having  kids  otherwise,  given  their 
religious  teachings. 

Crawford:   Doctors  prescribe  it  when  it's  not  necessary? 

Blum:      Well,  they  just  do  it  whether  it's  medically  necessary  or  not. 
When  a  woman  is  getting  desperate  with  her  third  or  fourth  kid, 
one  every  nine  months,  she  wants  something  done,  and  responsive 
doctors  will  find  something.   You've  got  pains,  you've  got 
aches,  you've  got  bleeding,  you've  got  something,  but  a  woman 
cannot,  on  her  own,  use  birth  control  in  many  religions.   But 
if  a  doctor  says,  "I  think  you  should  have  a  hysterectomy," 
then  the  woman  can  thank  the  Lord  and  go  on  about  her  business 
knowing  that  she  has  not  violated  any  religious  teachings. 

Crawford:   And  that  was  this  case? 

Blum:      Yes.   It  doesn't  sound  altogether  ethical,  but  I  don't  think  it 
was  unethical.   If  that's  what  she  wanted,  that's  her  business. 
But  he  was  parading  as  a  good  Catholic  doctor,  too.   I 
commenced  to  see  that  this  was  one  more  reason  that  I  would  do 
better  in  public  health  as  I  waded  through  medical  school. 

Crawford:   This  is  what  you  were  seeing? 

Blum:  Yes.  There  were  all  kinds  of  remarkable  things.  Nearly  half 
the  students  in  my  class  were  Jewish.  Seventy  percent  of  the 
patients  were  Irish,  Italian,  or  French  Catholic. 

We  were  never,  ever  given  one  word  about  the  fact  that 
these  people  might  not  believe  in  the  things  that  we  believe 
in.   We  were  very  casual  about  hysterectomies.   You  don't  want 
any  more  babies,  that's  no  great  sin.   Go  do  it.   Yet  that's  a 
real  sin  for  a  Catholic. 

Crawford:   And  that  bothered  you  at  the  time? 


71 


Blum:      You  commence  to  wonder.   We  don't  know  anything  about  these 

people.   We  just  treat  them  like  they're  one  of  us,  and  they're 
not.   Then  you  wonder  why  they  often  don't  do  what  you  tell 
them,  better  known  as  non-compliance. 

Crawford:   So  you  felt  that  you  were  coercing  them? 

Blum:      I  don't  think  we  even  thought  that  hard.   I  don't  think  more 
than  one  or  two  of  us  ever  thought  about  it .   We  never  had 
discussions  of  these  kinds,  but  in  my  mind  it  was  kind  of 
obvious.   I  was  always  aware  of  race  and  ethnicity  and  that 
sort  of  thing,  given  my  background.   So  it  struck  me  that  we 
were  being  less  than  wonderful  doctors. 

We  were  also  taught  the  most  stringent  statistics.   These  I 
called  Mayo  statistics.   They  usually  came  from  a  place  like 
that.   You  had  a  patient  with  gall  bladder  disease,  an  acute 
inflammation,  and  if  you  didn't  operate,  you  would  have  5 
percent  mortality;  if  you  did  operate  you  would  have  a  1 
percent  mortality.   These  were  known  as  Mayo  indications, 
teaching  us  how  to  be  a  good  doctor.   The  only  thing  that 
nobody  ever  seemed  to  mention  was  that  we  were  getting  Mayo 
indications  for  surgery,  but  we  weren't  learning  how  to  do 
surgery  like  they  do  at  Mayo.   We  don't  even  know  how  to  do 
surgery,  yet  we're  going  out  to  do  practice  with  that  kind  of 
irrelevant  guidance. 

The  thing  was,  if  I  went  out  to  be  a  family  practitioner, 
I'd  remember,  "We're  better  off  operating."  That  would  be  true 
if  you're  a  Mayo  surgeon,  but  it  ain't  true  if  you're  a  Cal 
general  practitioner. 

Crawford:   But  that  was  the  sense  of  it? 

Blum:      The  sense  of  it  was  you  had  to  memorize  this  garbage  about  when 
to  step  in  and  when  not.   This  is  not  irrelevant.   What  we 
should  have  been  taught  was,  if  you're  a  G.P.,  you'll  probably 
get  20  percent  mortality;  if  you're  a  good  surgeon,  1  percent; 
if  you  leave  them  alone,  6,  so  make  up  your  mind  what  you  are 
and  act  appropriately. 

Crawford:   Now,  at  that  point,  if  you  graduated  and  went  to  be  a  G.P., 
would  you  also  be  a  surgeon? 

Blum:      You  could  be.   The  bulk  of  general  practitioners  were.   It's 

where  the  fun  was ,  and  the  money  was ,  yet  you  might  only  have  a 
year's  more  training,  or  you  might  not  even  have  that. 

Crawford:   Not  up  to  Mayo  standards. 


72 


Blum:      Well,  I  know  where  Mayo  got  their  standards.   They're 

describing  the  work  done  by  Mayo  surgeons.   In  good  hands,  yes, 
it's  much  better  to  have  your  gall  bladder  taken  out.   But  we 
medical  students  kept  seeing  disasters  from  docs  who  had  done 
this  or  that  surgery  and  sent  what  was  left  of  the  patient  back 
to  UC  to  patch  them  up. 

This  isn't  positive  learning.   So,  more  and  more,  I  kept 
moving  towards  what  I  might  have  done  anyway,  and  that  was 
public  health,  saying,  "That's  where  I'm  really  going  to  go." 

Crawford:   Was  that  evident  to  you  in  your  first  year,  already? 

Blum:      Well,  maybe  not  first  year,  but  in  the  third  year  when  we 

really  started  seeing  patients.   It  struck  me  that  there  were 
going  to  be  better  uses  of  my  talents,  some  broader  aspect  of 
things.   Much  of  what  we  saw  was  unnecessary  illness  and  could 
have  been  prevented.   We'd  also  see  a  lot  of  seriously  ill 
people  who  could  have  been  treated  better,  differently.   I 
remember  we  had  a  visit  from  someone  at  Yale,  a  famed  teacher 
and  practitioner  who  went  on  to  become  a  critical  figure  in 
public  health,  C.E.A.  Winslow.   I  suspect  his  name  is  on  that 
award  I  got  from  public  health. 

Crawford:   Is  that  the  Sedgwick  Prize? 

Blum:      Yes.   I'm  sure  he's  on  that  list  of  awardees.   Well,  he  came  to 
lecture  to  us.   It  was  marvelous  and  we  got  wildly 
enthusiastic.   Public  health  was  very  tempting,  and,  again,  it 
fit  in  with  my  notions  of  how  things  ought  to  be  done  —  that  we 
ought  to  get  there  sooner,  and  it  shouldn't  be  dependent  upon 
whether  people  have  the  money  to  pay  for  it. 

Crawford:   Was  the  hospital  treating  people  who  couldn't  afford  treatment? 

Blum:      Yes.   Many  if  not  most  of  the  people  we  practiced  on  were 

charity  cases.   At  nearly  all  the  medical  schools,  this  was  the 
case.   Of  course,  that's  another  travesty:  teaching  on  the 
poor.   You  learn  all  sorts  of  bad  habits  because  these  people 
are  very  different  in  many  ways,  very  dependent,  and  had  little 
if  any  freedom  of  choice. 

I  could  give  you  all  kinds  of  examples.   I  remember  when  I 
was  a  junior,  one  of  the  famous  professors  at  Cal  was  treating 
a  patient.   The  patient  was  hard  of  hearing.   Four  students 
were  standing  around  the  bedside,  and  the  patient  wanted  to 
know  something  and  said  something  to  the  effect  that  she 
couldn't  hear  us.   She  was  hard  of  hearing,  and  our  professor 
shouted  at  her,  "Lady,  there's  nothing  worth  hearing  these 


73 


days,  anyway."  And  shut  her  up. 
touch  at  the  county  hospital. 


This  was  a  common  patient 


I  taught  medicine  at  Stanford  in  the  city--their  medical 
school  used  to  be  in  San  Francisco--and  I  taught  for  ten  years 
there.   Then  Stanford  moved  its  medical  school  to  Palo  Alto  in 
1960.   In  San  Francisco  we  used  to  have  mostly  ghetto  patients 
in  the  clinics.   When  we  went  to  Stanford  in  Palo  Alto,  no. 
There  were  no  ghettos.   True,  a  few  of  our  patients  followed 
us—actually  found  their  way  down  there;  but  I  couldn't  believe 
the  difference.   For  instance,  in  San  Francisco,  patients  often 
had  everything  removed  out  of  them.   You  had  a  symptom  here  and 
a  symptom  there,  well,  we'll  take  out  your  thyroid,  we'll  take 
out  your  stomach.   I  mean,  all  justifiable,  but  you  might  have 
a  patient  who  was  minus  everything  that  was  removable  by  age 
thirty.   Down  on  the  Farm  there  was  none  of  that  nonsense.   I 
mean,  these  people  are  workers,  business  people,  professional 
people,  merchants.   You  don't  routinely  put  anybody  to  bed  with 
their  ulcers  —  stomach  ulcers  —  like  we  did  at  Stanford  in  San 
Francisco.   They  had  work  to  do  and  were  helped  to  do  it. 

Crawford:   And  this  was  the  fifties? 

Blum:      This  was  from  '50  to  '60.   Of  course  it's  different  now.   But  I 
went  with  Stanford  and  taught  down  there  on  the  farm  a  couple 
of  years.   The  commute  was  a  little  much  for  me,  though;  I 
lived  in  Walnut  Creek  and  worked  in  Martinez.   The  first 
patient  I  worked  up  at  Stanford  had  been  a  Caterpillar  driver. 
The  Cat  overturned,  crushed  his  shoulder  but  good— so  that 
there  was  no  way  Stanford  or  anybody  else  was  going  to  restore 
the  function  of  his  arm  and  shoulder.   The  medical  student  who 
presented  the  case  to  me  — a  senior  medical  student  — came  up  to 
me  saying  the  patient  has  a  date  for  vocational  rehab.   We've 
figured  out  he's  going  to  be  a  tractor  salesman.   He  knows 
tractors  backwards  and  forwards.   This  is  a  new  world.   I 
looked  at  this  student,  neither  faculty  nor  students  had  ever 
heard  of  voc.  rehab,  in  the  city.   There  they  were  only  dealing 
with  poor  discards  who  never  had  a  chance;  and  here  we  have  a 
patient  and  we  are  already  fixing  him  up  to  go  back  to  a  good 
job.   This  a  new  world  and  it's  because  we're  not  just  dealing 
with  the  desperately  poor. 

Crawford:   Was  that  a  function  of  too  many  numbers  when  you  were  in  the 
clinics? 

Blum:      No.  When  you  always  practice  on  the  poor,  you  kind  of  give  up, 
because  such  people  have  so  little  going  for  them.   When  you 
always  work  on  the  poor,  so  what  can  you  expect,  so  what  can 
you  do  to  make  the  necessary  changes  to  let  them  lead  a 


Crawford: 
Blum: 


healthier  life?  They've  got  to  go  back  home.   They're  not 
going  to  have  this,  they're  not  going  to  have  that.   I  learned 
at  that  point  clearly  why  doctors  became  so  asocial,  paid  no 
attention  to  patients  or  their  lives  or  their  problems.   There 
was  very  little  you  could  do  about  it.  We  had  social  workers 
at  Stanford  in  San  Francisco.   All  they  ever  were  concerned 
about  was  how  much  money  you  could  get  out  of  the  patient  or 
from  someone  on  their  behalf.   Our  patients  in  the  clinics  were 
poor.   They  came  from  the  black  ghetto  right  around  Fillmore. 

What  could  they  pay? 

Nothing,  or  very  little,  so  that  was  all  right,  too;  but  the 
point  is  that  you  don't  spend  your  time  figuring  out  what  they 
should  be  doing  for  a  living,  or  how  they  should  be  doing  it, 
and  yet  this  was  your  workday  in  and  out.   This  was  how  you 
were  learning  to  practice,  so  that  when  you  practiced  on  your 
own  patients  you  still  ignored  preventive  measures  or  social 
needs. 


I  remember  another  patient  I  had  in  San  Francisco,  Mr. 
Redmond.   A  big,  tall,  handsome,  black  man,  in  pretty  good 
shape;  but  when  I  examined  him,  his  liver  was  down  to  his 
pelvis. 

Crawford:   Enlarged  liver? 

Blum:      Enlarged  liver,  and  I  said,  "Do  you  drink?"  He  said,  "Oh,  yes, 
I  drink  at  least  a  fifth  every  day."  He  said  sometimes  more, 
and  all  this  very  calmly.   I  said,  "Your  liver--the  next  thing, 
it's  going  to  shrink  up,  and  you're  going  to  be  done  for. 
You're  going  to  have  cirrhosis  of  the  liver.   You'll  never  make 
it  back,  next  year,  for  a  check-up.   You'll  be  gone." 

Crawford:   How  old? 

Blum:      Oh,  maybe  forty.   And  I  never  expected  to  see  him  again.   One 
year  later--my  charts  are  laid  out—and  I  looked  at  this 
Redmond's  chart,  and  he's  still  alive.   I  can't  believe  it. 
So,  I  go  out  there  and  I  say,  "Mr.  Redmond,"  and  I'm  looking 
around.   Here's  this  sharp,  young-looking  guy,  and  I  said, 
"You're  supposed  to  be  dead."  He  said,  "Yes,  I  know  it.   You 
told  me  that  last  year.   Well,  I  stopped  drinking."  You  see,  I 
hadn't  even  bothered  to  tell  him  to  stop  drinking.   I  did,  and 
I  didn't,  if  you  know  what  I  mean,  it  was  implied,  but  I 
expected  no  results  and  I  didn't  try  for  any. 


Crawford:   Many  times  maybe  you  hadn't  seen  any  results? 


75 


Blum:      That's  right.   These  are  poor  people;  they  do  what  they  do.   We 
act  as  though  they're  hopeless.   He  told  me--I  didn't  even  know 
this—he  said,  "I  used  to  kill  cattle  in  the  slaughterhouse  in 
South  San  Francisco.   My  job  was  hitting  the  cattle  and  the 
sheep  over  the  head  with  a  pipe."  He  said,  "You  can't  do  that 
without  keeping  yourself  pretty  well  drunk  all  the  time.   It's 
a  horrible  job:  they  cry,  they  scream,  it's  awful.   So  I  quit 
the  job,  and  I  got  a  job  down  on  the  Peninsula  on  an  estate, 
and  outside,  and  it's  wonderful." 

Crawford:   You  turned  his  life  around. 

Blum:      Yes,  but  look  how  I  went  about  it,  if  you  see  what  I'm  getting 
at.   No  concern  at  all  for  the  man  or  his  life,  saying,  "Hey, 
you're  going  to  kill  yourself.   Do  something."  You  kind  of 
shut  off  all  the  social  and  psychological  concerns.   Finally, 
after  a  few  such  cases,  you  may  start  pursuing  it,  pursuing  it, 
and  I  did. 


I  did  a  lot  of  it  at  Stanford.   In  fact,  that  convinced  me 
that  I  could  never  practice,  that  I  would  always  be  taking  care 
of  desperately  poor  people  with  serious  problems,  and  I  could 
never  make  a  living.   Also  I'd  go  crazy  earning  that  kind  of 
living,  with  that  clientele  who  had  so  little  support. 

Crawford:   You  could  have  left. 

Blum:      Oh,  yes,  but  such  patients  gravitated  to  me.   I  won  a  prize 

there,  once,  at  Stanford  when  I  was  a  resident.   It  turned  out 
after  about  six  months  in  the  new  year  the  faculty  took  some 
sort  of  a  patient  poll  as  to  who  was  their  favorite  young 
resident,  and  I  won  it.   I  can  see  why.   All  my  customers  had 
been  discarded  by  other  people.   Discarded. 

Crawford:   So  it  was  your  patients  who  voted  you  in? 

Blum:      Sure,  because  you're  spending  time  on  them.  But  you  can't  make 
a  living  on  them.   You  try  to  get  resources.   You  can't  do  it, 
so  you  fall  back  on  the  old  ways  and  don't  love  yourself  for 
it. 

Crawford:   What  resources  were  lacking? 

Blum:      Well,  I  mean,  somebody  to  help  them  get  jobs,  somebody  to  help 
them  to  go  to  school,  somebody  to  help  them  think  through  how 
to  get  their  lives  together.   That's  what's  critical.   That's 
medicine.   When  you  practice  on  the  poor,  you've  got  problems 
bigger  than  the  textbook  medical  ones. 


76 


Crawford: 
Blum: 


Today  there  are  some  interesting  exceptions.   There  are 
parts  of  San  Francisco  General  Hospital,  which  is  UCSF,  which 
are  good.   They  really  do  quite  a  job.   They  speak  forty 
languages  in  some  of  those  clinics. 

I  remember  at  Stanford,  I  couldn't  get  over  that,  a 
patient—a  Japanese  lady—she  could  barely  get  along  with  a 
translator,  and  they  gave  her  Chinese  forms  to  fill  out.   I 
called  the  social  worker,  and  I  said,  "This  lady's  not  Chinese. 
She's  Japanese."  She  said,  "The  alphabet  and  language  look  the 
same."  Here  we  are  talking  about  taking  care  of  people,  but 
this  is  not  taking  care  of  people,  this  is  taking  care  of  your 
job. 

There's  a  black  lady  that  I'll  never  forget.   She  was  a 
husky  thing,  and  the  medical  student  spent  hours  working  her 
up.   Every  part  of  her  ached,  hurt,  and  almost  everything  had 
been  removed  that  was  removable.   Her  name  was  Mrs.  Jones.   She 
was  probably  thirty.   She  had  had  two  grades  in  Arkansas  or 
someplace.   She  looked  pretty  messy  and  disheveled  and  upset, 
and  the  student  presented  me  the  case  saying,  "This  is  a 
retarded  black  woman,  thirty  years  old."  Well,  I  got  a  little 
antsy  about  that.   All  black  women  are  retarded  to  persons  in 
some  walks  of  life.   This  lady  had  had  everything  removed  from 
her:  her  thyroid,  half  her  stomach,  her  appendix,  her  uterus, 
ovaries,  gall  bladder. 

How  can  you  be  without  a  thyroid? 

She  had  part  of  it  left  and  you  replace  it  with  drugs.   One  or 
another  symptom  had  led  to  all  these  repairs,  and  a  lot  of 
residents  got  a  lot  of  good  training  in  surgery.   Not 
necessarily  at  Stanford.   She  was  from  elsewhere,  but  that's 
how  it  was  done.   I  worked  her  up  with  the  same  student 
standing  alongside  me.   I  went  completely  over  her  again, 
everything  about  her.   She  told  me  about  her  thyroidectomy,  her 
oophorectomy,  her  hysterectomy,  her  partial  gastrectomy.   I 
kept  watching  the  student  because  those  are  the  words  that  she 
used- -he  hadn't  yet  learned  them  all.   This  lady  was  a 
brilliant  woman:  this  dishevelled,  uneducated,  "retarded"  black 
woman.   I  didn't  make  any  great  progress,  but  noted  that  she 
had  ulcer  pains  again.  With  the  stomach  mostly  removed,  that 
could  be  curtains. 

The  student  had  to  go  to  class,  and  I  took  over  and  got  her 
squared  away—spent  a  little  time  with  her— then  dismissed  her 
with  ulcer  prescriptions  which  she  could  get  filled  free,  and  a 
fairly  liberal  diet.   I  was  sitting  up  there  writing  all  this 
in  her  chart  about  5:30— it  just  was  endless  — and  I  hear  this 


77 


clomp,  clomp,  clomp  up  the  stairs  of  the  old  beat-up  building 
we  worked  in.   I  think  I've  told  you  about  Bloomfield  welcoming 
me  to  Stanford,  didn't  I?  Well,  that  was  the  building  where 
that  happened.   So,  she  bursts  in  on  me,  and  she  says,  "Doctor! 
My  husband's  leaving  me."  This  is  why  she  was  there.   This  is 
a  whole  other  ball  game,  and  we'd  never  gotten  a  clue  about  it 
acting  as  her  medical  doctor. 

The  next  year  I  went  to  Harvard  and  bumped  into  some  people 
whose  lectures  emphasized,  "and  you  don't  know  anything  about 
your  patients  unless  you  know  why  they're  here  today."  Well, 
that's  why  she  was  there.   So  we  sat  down,  and  it  was  a  very 
different  discussion;  she'd  been  kissed  off  and  every  removable 
piece  of  her  had  already  been  removed.   So  I  said,  "Well,  let's 
pick  up  the  phone  and  talk  to  the  district  attorney.   Who 
knows?   It's  Friday  night,  and  maybe  he's  sitting  there." 

Well,  sure  enough,  we  got  a  San  Francisco  Assistant  D.A. , 
and  he  started  talking  to  her.   I  listened  in.   He  was  saying, 
"Lady,  you  don't  know  when  you're  well  off.   You  don't  need 
that  kind  of  a  husband.   Nobody  needs  a  husband  like  that."   So 
we  sent  her  on  her  way,  convinced.   You  should  have  seen  her  in 
the  clinic  the  next  week,  after  she  had  pills  to  cut  her  pain, 
and  a  new  diet.   Oh,  yes.   I  also  told  her  she  could  go  to 
work.   Previous  clinics  told  her  that  since  she  had  ulcer  pains 
she  should  be  in  bed. 


Crawford:   Did  she  have  ulcers? 

Blum:      Undoubtedly,  but  we  did  no  more  x-rays.   She  had  most  of  her 

stomach  gone.   With  the  medications  and  real  food  and  a  job,  a 
week  later  here  comes  this  nice-looking,  powerful  woman--a 
totally  different  person,  all  cleaned  up  and  sharp,  two  years 
of  schooling--and  she's  feeling  better.   I  said,  "Go  get 
yourself  a  job.   What  can  you  do?"   She  said,  "I  can  do  laundry 
work,"  and  she'd  already  gotten  a  job—strong  as  a  horse,  what 
was  left  of  her.   She  was  feeling  good. 

So  you  see  the  difference.   You've  got  to  look  at  the 
patient.   But  traditionally  you  haven't  got  time  to  care  for 
ghetto  people.   Do  the  best  you  can  and  be  gone.   Well,  that 
was  just  before  we  moved  to  Stanford,  down  on  the  Farm.   When 
we  left  we  had  a  party  for  all  of  the  patients  in  our  clinic. 
We're  leaving  them  in  the  lurch,  but  it's  the  best  we  can  think 
of  doing.   Stanford  is  moving  to  the  Farm.   At  the  party  I  see 
that  Mrs.  Jones  looks  ill  and  I  asked  her  what  was  the  matter. 
She  said,  "My  husband  came  back." 


78 


More  about  Medical  School  and  Student  Activism 


Blum:      I'd  taken  ROTC  in  medical  school,  and  the  war  broke  out  just 
before  I  graduated.   I  graduated  in  July  of  '42,  and  the  war 
formally  started  with  the  December  attack  by  Japan  in  1941. 
I'd  already  been  to  ROTC  summer  camp  down  at  Fort  Ord,  and  that 
really  clinched  my  choice  of  a  career  because  we  went  on 
maneuvers.   Fort  Lewis  invaded  us  down  at  Fort  Ord  and 
destroyed  our  kitchens  and  everything.   These  were  games,  but 
it  was  truly  a  horrific  experience. 

We  were  all  medical  students.   We  were  reserve  officers, 
ROTC.   I  was  the  tallest  one  of  our  group  at  ROTC,  and  the 
smallest  man  and  I  got  all  the  non-fitting  uniforms.   He  got 
all  the  small  ones  that  didn't  fit  anybody,  and  I  got  all  the 
big  ones  that  didn't  fit  anybody.   They  just  threw  them  at  us. 
So  we'd  keep  trading  until  we'd  get  a  better  fit.   Poor  little 
Mel,  he  never  did  get  anything  more  than  atrocities;  and  I  got 
all  these  huge  things  that  didn't  really  fit  me,  but  I  had  room 
for  a  lot  of  food.   So,  when  we  went  on  maneuvers,  I'd  fill  my 
outfit  with  cheese  and  chocolate  bars:  a  regular  walking 
commissary.   [laughs] 

Our  major- -who  was  a  true  idiot,  a  physician- -walked  us 
through  the  fields  where  the  live  ammunition  was  supposed  to  be 
landing. 

Crawford:   Where  was  this? 

Blum:      Fort  Ord.   Then,  when  we  were  captured  by  the  enemy- -by  the 
Fort  Lewis  people--!  got  to  see  some  real  doctors  who  were 
really  in  the  army.   They  didn't  even  own  a  stethoscope.   I 
thought,  oh,  no.   I'm  not  getting  all  this  training  to  go  be 
something  like  our  dumb  major,  walking  people  through  targets. 

When  we  got  back  to  San  Francisco  in  September  or  October, 
we  had  a  choice  of  the  army,  the  navy,  the  air  corps,  the 
public  health  service,  the  CIA.   Well,  there  were  a  whole  bunch 
of  agencies,  and  you  could  be  going  into  any  of  these;  but  I 
went  in  the  public  health  service  because  I  knew  they  had  all 
these  marine  hospitals,  and  they  were  doing  medical  care  for 
the  coast  guard  and  the  merchant  marine.   Over  time,  I  learned 
more  about  it.   They  also  were  the  doctors  for  the  commandoes, 
and  they  were  the  doctors  who  went  on  the  Burma  Trail;  all 
sorts  of  goodies.   So  there  were  some  exciting  parts  to  it. 

Crawford:   Before  we  go  on  with  that,  let's  get  you  out  of  medical  school. 


79 

Blum:      I  simply  got  absorbed  into  the  public  health  service.   When  I 
graduated,  I  went  to  the  San  Francisco  Marine  hospital  as  an 
intern  and  was  an  officer  in  the  armed  forces,  uniforms  and 
all. 


^HBIHPIIIpk  mk  ••••••• 


/„•- 


BBHHkftiJBBBHI  J^^^W*  -^* 


Entering  Medical  School  at  University  of  California,  San  Francisco,  1938. 


Medical  ROTC,  July  1,  1940  (Dr.  Blum  at  far  left) 


Entering  the  U.S.  Public  Health  Service  in  1941 

as  an  intern. 


80 


IV  SERVING  IN  THE  U.S.P.H.S.  IN  WORLD  WAR  II--PART  OF  THE 
ARMED  SERVICES:  1942-1946 


An  Internship  at  the  Marine  Hospital  in  San  Francisco  and  a 
Brief  Stint  at  a  Venereal  Disease  Hospital  in  Arkansas 


Crawford:   What  was  the  term  of  residency  and  internship? 

Blum:      Well,  when  I  went  into  the  service,  I  went  to  the  Marine 

Hospital  in  San  Francisco,  and  I  was  out  of  UC,  gone,  gone.   I 
got  my  internship  in  the  service.   I  graduated  in  July  and  I 
was  already  assigned  in  June  to  the  San  Francisco  Marine 
Hospital. 

Crawford:   So  you  weren't  drafted? 

Blum:       It  was  the  equivalent  of  drafted.   If  you  were  drafted,  you 
might  not  go  as  a  doctor,  but  if  you  signed  up,  you  could  go 
for  what  you  were.   So,  in  June,  I  picked  out  the  U.S.  Public 
Health  Service;  and  in  July  reported  for  duty  in  uniform.   That 
was  a  whole  fiasco,  too. 

Crawford:   This  is  one  of  those  ridiculous  situations?   [laughter] 

Blum:      The  Public  Health  Service  is  kind  of  sloppy  about  military 

distinctions,  but  you've  got  to  get  a  uniform.   Well,  I  went 
down  to  the  uniform  store. 


Crawford:   Where  was  this? 

Blum:      San  Francisco.   And  they  gave  me  the  wrong  uniform.   So  I  show 
up,  and  everybody  says,  "You  can't  wear  this  and  you  can't  wear 
that."  The  basics  were  all  right.   It  was  the  right  color,  but 
the  gold  braid  was  wrong,  and  so  on.   I  remember  one  of  my 
first  tasks  was  to  go  down  and  take  somebody  off  a  ship,  an 
injured  sailor.   Here  I  am,  climbing  up  the  ladder  in  my 
uniform  and  I  don't  know  whether  to  salute  the  front  end  of  the 


81 


ship,  the  back  end  of  the  ship,  the  captain  who's  waiting  for 
me- -I  don't  know  anything. 

Well,  you  just  feel  like  an  idiot.   You're  walking  down  the 
street,  as  I  did  with  my  wife  the  day  after  I  got  my  uniform, 
and  she  said,  "What  are  those  men  doing?  Looks  like  they're 
saluting  you."   I  said,  "Oh,  my  god.   They  must  be."   So  then  I 
had  to  salute  them  back,  you  see,  and  nobody's  given  you  a  book 
to  read,  nothing. 

Finally,  I  found  a  book  in  the  library  in  the  Marine 
Hospital  where  I'm  doing  my  internship  and  it  shows  a  dress 
uniform.   Well,  I  don't  know  whether  we  have  to  ever  use  a 
dress  uniform.   I  look  at  the  front  of  the  book.   It  was 
written  in  1914.   That's  the  latest  word  on  Public  Health 
Service  uniforms  in  the  1940s. 

It  was  just  one  big,  fun  game;  but  I  had  some  good  doctors 
to  work  under  at  the  Marine  Hospital  in  San  Francisco,  and 
enough  time  to  really  study.   I  studied  like  crazy,  and  learned 
a  lot.   I'd  taken  my  license  exams  to  practice  in  California 
just  before  I  started  my  internship.   So  I  was  licensed  to 
practice  in  California. 


Blum:      A  few  strange  diversions.   There  were  some  ridiculous  aspects 
to  the  assignment,  to  be  sure.   One  day  I  was  on  ambulance 
duty,  heard  the  siren  at  about  nine  a.m.,  pulled  my  uniform 
together  and  headed  out  to  the  emergency  portico.   We  had  the 
most  beautiful  ambulance  in  San  Francisco,  a  grey  Packard  with 
a  siren  on  the  roof  that  looked  to  have  about  a  five-horsepower 
motor.   I  jumped  in,  the  two  techs  tooled  out,  the  siren  going 
full  blast  while  we  proceeded  at  about  fifteen  miles  per  hour. 
The  men  were  already  pretty  well  looped  and  fortunately  were 
the  kind  that  went  slowly,  not  rapidly  as  a  consequence.   Our 
siren  stirred  everyone  in  the  neighborhood.  We  finally  ended 
up  about  five  blocks  away,  parked  in  front  of  Shnibben's  bar, 
gathering  a  crowd.  My  two  men  got  some  beers  and  sandwiches, 
and  then  we  headed  down  the  coast  to  pick  up  an  officer  who  had 
had  a  heart  attack. 

It  was  a  picnic  the  ambulance  men  had  in  mind.   I  was  going 
nuts.   We  did  get  the  man  back  alive,  but  no  thanks  to  us. 

Towards  the  end  of  our  year  I  was  on  urology.   As  we  were 
making  rounds  one  morning,  our  chief,  a  fairly  young  man,  was 
summoned  away,  and  I  never  laid  eyes  on  him  until  four  years 
later  at  a  party.   He  told  me  that  he  had  been  flown  to  his 


82 


next  assignment,  sea  duty,  that  same  morning.   He  was  assigned 
to  a  ship  under  construction  and  spent  the  year  in  Long  Beach 
watching  the  ship  being  built.   By  the  time  a  year  had  gone  by 
the  ship  was  launched  and  he  was  relieved  as  he  had  put  in  one 
year  of  sea  duty. 

ft 

Blum:      I  finished  my  year  in  the  Marine  Hospital,  and  then  was 

assigned  to  Arkansas.   In  Arkansas,  I  worked  in  a  venereal 
disease  hospital:  four  hundred  beds,  scores  of  new  patients  a 
day,  I  mean  every  day.   On  the  first  day  I  go  out  to  the  clinic 
and  I  say,  "Mr.  Smith."  A  black  man  comes  shuffling  up.   These 
are  very  badly  educated  people.   I  examine  him,  doing  whatever 
has  to  be  done,  and  then  another  one,  and  another  one. 

Toward  noon  I  get  a  little  message,  "Please  go  see  the 
commanding  officer  at  noontime."  Well,  I  knew  him,  so  that 
didn't  bother  me  too  much.   I  went  over  to  see  the  commanding 
officer,  who  is  a  bright  young  major,  not  much  older  than  I  am. 
He  said,  "For  christsakes,  you've  got  to  stop  calling  all  those 
black  people  mister  and  missus.   You're  just  starting  a  ruckus 
here."   I  said,  "Where  I  came  from,  they  were  citizens  just 
like  anybody  else."  He  says,  "Don't  tell  me.   I'm  from 
California,  too,  and  I  know  all  about  it;  but  you're  setting 
the  stage  for  trouble  for  these  people.   They're  going  to  be 
beaten  up,  they're  going  to  be  discriminated  against  by  the 
whites  who  are  here.   You  call  a  black  person  mister  and 
missus,  you're  setting  the  stage  for  some  awful  thing  for 
them."   So  I  started  learning  about  the  South.   I  listened  to 
him,  and  you  say  "Mary"  and  "Sam"--a  different  world.   From 
there  I  was  shipped  to  a  research  center. 

Crawford:   And  how  long  were  you  there? 

Blum:      Oh,  just  six  weeks,  but  it  was  a  revelation. 

Crawford:   I  see,  and  you  were  what  rank? 

Blum:      As  an  intern,  I  had  one  stripe.   In  Arkansas  I  got  my  stripe 
and  a  half,  and  was  a  junior  grade  lieutenant. 

Crawford:   Lieutenant  J.G.? 

Blum:      Yes,  I  was  really  moving.   In  Hot  Springs  I  met  a  person  who'd 
been  two  classes  ahead  of  me  at  UCSF,  who  had  also  been  number 
one  in  his  class.   He  was  well  on  his  way  to  being  Surgeon 
General,  and  he  did  become  Assistant  Surgeon  General. 


83 


Crawford:   What  was  his  name? 

Blum:      David  Price,  lovely  man.   There  he  was,  in  charge  of  the  wards 
that  I'm  working  on  in  this  Arkansas  hospital.   And  he,  too, 
was  just  marking  time.  We  were  waiting  for  them  to  move  him  up 
to  something  else.  We  renewed  conversations,  and  in  a  way  I 
had  probably  followed  his  tracks.  As  a  student  I'd  known  he'd 
gone  into  the  Public  Health  Service.   He  was  a  very  bright, 
nice  person.   There  was  another  such  person  ahead  of  him,  three 
of  us  in  a  row—three  number  ones  from  three  classes—that  had 
done  the  same  thing.   The  other  one  became  an  Assistant  Surgeon 
General  too.   I  did  not. 

Crawford:   Did  your  high  ranking  as  a  student  affect  your  assignment? 

Blum:      Ultimately,  perhaps;  no  way  of  telling.   This  man  had  probably 
two  or  three  stripes,  and  I  had  one  and  a  half;  but  he  was  nice 
to  work  for.   It  wasn't  unusual.   I'd  worked  under  him  when  he 
was  a  resident  and  I  was  a  student.   It  was  old  times  again. 


A  VD  Research  Project  at  the  Penitentiary  in  Terre  Haute, 
Indiana 


Blum:      From  there,   I  was  sent  to  the  Venereal  Disease  Research  Lab  in 
Staten  Island,  New  York,  which  is  a  very  famous  one,  and  is 
where  they  discovered  the  use  of  penicillin  for  syphilis  just 
before  my  arrival.   My  assignment  there  was  ultimately  to  go  to 
Terre  Haute  for  a  year  as  part  of  a  research  team,  and  work  in 
the  penitentiary  on  human  guinea  pigs.   We  had  our  own 
penicillin  plant— at  that  time  we  couldn't  get  penicillin,  so 
we  made  our  own.   My  first  job  at  Staten  Island,  my  first  day— 
they  don't  waste  any  time— was  to  go  collect  the  urine  of  all 
the  people  in  the  hospital  who  had  been  given  penicillin  the 
day  before  because  you  can  get  the  penicillin  back  out  of  the 
urine.   We  purified  it  and  used  it  all  over  again. 

Crawford:   Is  that  true? 

Blum:      Oh,  yes.   Sure.   The  body  takes  it  in,  and  most  of  it  is 

excreted  in  the  urine.   It  was  cheaper  at  that  time  to  do  that 
than  to  make  a  new  batch.   Then  we  were  shipped  to  Terre  Haute, 
and  that  was  an  experience.   I  told  you  about  my  research 
experiences  and  my  senior  officer  there  in  my  opening 
discussion  of  this  history. 


In  Terre  Haute  people  didn't  know  there  was  a  war;  a  wee 
bit  isolated,  and  they  resented  people  in  uniform.   They 
couldn't  go  hunting  because  they  didn't  have  bullets  and  they 
really  denounced  the  government,  and  their  children  were  in  the 
service!   The  people  next  door  had  stacked  over  a  hundred  one- 
pound  tins  of  coffee—nice  people—but  the  war  didn't  involve 
them  at  all.   At  the  same  time  Terre  Haute  had  a  wonderful  art 
museum.   The  city  was  most  famous  for  being  the  home  of  Calumet 
Baking  Powder. 

Crawford:   You  went  into  that  story  quite  a  bit.   How  do  you  evaluate  it 
now?  How  do  you  weigh  it  in  terms  of  the  impact  that  that  had 
on  you? 

Blum:      The  Terre  Haute? 
Crawford:   Yes. 

Blum:      Oh,  it's  just  surprising  that  you  do  those  things.   You  just  do 
them.   In  retrospect  you  start  sweating  it.   I  knew  we  were 
doing  bad  research,  but  nobody  seemed  to  care,  so  what  could  I 
do?   I  was  just  a  junior  officer  with  all  these  people  above 
me,  right  up  to  an  Assistant  Surgeon  General,  and  nobody 
listened,  so  that  was  that.   You're  not  going  to  be  a  whistle- 
blower  in  the  service  during  the  war,  that's  for  sure.   At 
least,  that's  how  you  feel  when  you're  in  the  service.   When 
you're  outside,  you  say,  "Well,  you're  supposed  to  be  a 
whistle-blower.   What  kind  of  conscience  do  you  have?"   It's  a 
real  problem. 

One  of  my  physician  friends  from  another  outfit  was 
stationed  in  Texas.   He  went  to  a  bar  one  night  and  was  sitting 
next  to  a  Coast  Guardsman;  and  the  Coast  Guardsman  looked  at 
his  insignia  and  he  said,  "You're  in  the  Public  Health  Service. 
Well,  I'm  Coast  Guard,  and  you  guys  take  care  of  us,  you  know?" 
"Yeah,  that's  true."  They  got  talking  about  my  case,  and  this 
Coast  Guard  said,  "I  know  what  they  do  up  there  in  that 
penitentiary. " 

This  was  all  top-secret  research,  and  this  friend  of  mine 
says,  "What  is  it?   I've  often  wondered  what  he's  doing  up 
there."  This  sailor  said,  "Well,  they're  breeding  this  real 
tough  strain  of  gonorrhea;  and  they're  going  to  infect 
prostitutes,  and  they're  going  to  parachute  them  into  Germany." 
[laughs]   This  is  news.   So  my  friend  writes  this  to  me,  and 
I'm  sure  he  was  bright  enough  to  know  that  it  couldn't  possibly 
be  the  case,  but  who  knows?   So  that  was  our  top-secret 
research.   I  learned  a  lot  about  penitentiaries,  I  learned  a 


85 


lot  about  bad  research,  and  even  about  prison  breaks  on  my  last 
day  there. 

Crawford:   You  didn't  tell  me  about  the  break.   You  told  me  that  you  got 
quite  close  to  the  prisoners,  and  that  they  were  very  candid 
with  you  because  you  were  coming  in  from  outside. 

Blum:      Oh,  I  could  write  a  book  about  it,  and  a  kind  of  funny  book, 

too.   I  mean,  of  all  the  crazy  things  that  they  did,  and  of  the 
wonderful  food.   They  grew  it  all  themselves,  prepared  it  all 
themselves. 

Crawford:   Why  should  it  be  wonderful  food?  That's  interesting, 

Blum:      Because  they're  doing  it.   It  was  run  by  a  marvelous  warden.   A 
man  by  the  name  of  Swope.   In  any  event,  later  on  he  was  the 
last  warden  of  Alcatraz,  but  then  he  was  the  warden  at  Terre 
Haute.   We  got  to  know  him  well  as  his  guest  doctors. 

Crawford:   And  you  lived  in  Terre  Haute? 

Blum:      Yes.   Oh,  yes. 

Crawford:   You  didn't  live  at  the  prison? 

Blum:      No.   We  commuted  every  day  and  night,  just  a  few  miles  really. 
My  job--I  had  a  wonderful  job--one,  I  examined  prostitutes  to 
find  gonorrhea  bugs  to  bring  fresh  bugs  in  because  it  was  part 
of  our  experiment.   So,  I  was  doing  practical  work.   Another 
part  of  the  job  was  to  get  blood  for  the  laboratory  because 
bacteria  grow  on  blood  agar  best.   Horse  blood  is  fine,  so  it 
was  my  job  to  get  the  horse  blood. 

Crawford:   How  did  you  do  that? 

Blum:  Well,  they  taught  me  while  I  was  on  Staten  Island.  So,  I  get 
to  Terre  Haute,  and  I'm  the  horse  bleeder.  They  take  me  down 
to  a  boarding  stable.  They  have  the  most  beautiful,  gigantic 
Percherons,  like  the  beer  companies  have—big ,  lovely  animals. 

When  I  practiced  in  New  York,  we  went  to  riding  academies 
where  they  had  broken-down  race  horses;  and  we  had  a  twenty- 
foot  long  tube,  and  a  needle--a  fair-sized  needle,  about  as  big 
as  a  pencil—that  went  up  into  the  jugular,  and  then  you 
skedaddled  because  the  horses  went  wild.   I  mean  the  race 
horses  just  went  crazy. 


86 


Crawford; 
Blum: 

Crawford: 


Here  I  went  to  work  on  the  Percherons,  and  I  had  my  long 
tube,  and  I  stabbed  them,  and  the  Percherons  sort  of  flick 
their  necks.   [laughter] 

The  race  horses  were  that  much  more  sensitive  to  pain? 

Oh,  my.   I  mean,  it  was  a  wild  scene.   It  was  risking  your 
life,  and  here  are  the  Percherons  and  they  don't  even  notice 
the  needle. 


You  must  have  been  scared  to  death, 
horseman. 


You're  not  exactly  a 


Blum:      No,  but  you  were  going  to  do  the  job  in  the  service,  for  the 
service,  and  these  horses  and  the  prostitutes  were  equally 
insensible  to  my  presence.   I  mean,  it  didn't  make  a  bit  of 
difference  to  them. 

Crawford:   How  did  the  prostitutes  identify  themselves? 

Blum:      They  didn't.   They'd  been  picked  up  by  the  police.   Terre  Haute 
was  a  town  famous  for  its  prostitution  because  it  was  the  soft 
coal  mining  center.   The  miners  came  to  Terre  Haute  for 
recreation--R  &  R,  rest  and  recreation. 

Crawford:   Were  they  in  pretty  bad  shape? 

Blum:  No  worse  than  I've  seen  elsewhere.  I  had  plenty  to  do  with 
them  ultimately  in  San  Diego.  Similarly  in  Terre  Haute,  we 
worked  with  the  prisoners. 

The  jail-break  was  something  else  again.   The  security 
system  is  like  that  which  exists  in  private  homes  in  much  of 
Latin  America  now.   There  is  a  big  fence  around  one  end  of  the 
penitentiary;  and  there's  a  guard  house  with  a  guard  sitting  up 
in  a  loft  with  guns  who  watches  you.   You  come  in  under  where 
this  guard  is  perched,  and  he  lets  you  through  one  door  and 
talks  to  you  and  sees  who  you  are,  and  looks  at  your  insignia, 
but  he's  above  you,  out  of  reach.   At  least  he  was  in  that 
penitentiary.   Then  he  lets  you  through  the  next  gate  and  into 
the  yard.   There  you'd  be  visible  to  the  front  office  and  its 
many  guards  for  maybe  fifty  yards.   Then  you  come  to  another 
station  where  they  scrutinize  you  and  let  you  into  the 
penitentiary  building  itself. 

So,  I'm  coming  back  from  town  and  I've  got  a  jar  of  blood. 
It's  about  my  last  week  at  Terre  Haute.   I  get  in  through  the 
gates,  through  the  yard,  get  inside  the  prison  into  the  foyer. 
Here  all  the  guards  are  throwing  out  ammunition  belts,  machine 


87 


Crawford: 
Blum: 


guns,  and  all  sorts  of  armor,  putting  them  out  on  the  floor  and 
sorting  them  out,  each  person  taking  their  share.   I'm  looking 
and  thinking,  "Well,  they're  going  out  to  do  target  practice  or 
something."  I  never  thought  much  about  it. 

There  was  a  man,  the  associate  warden—not  the  guy  that  I 
said  was  such  a  fabulous  overall  warden,  but  his  chief  of  staff 
who  was  from  my  home  town,  from  Napa--a  big,  burly  fellow.   We 
knew  one  another.   I'd  been  there  almost  a  year.   He  looked  at 
me  and  he  said,  "Doc,  what  in  the  hell  are  you  doing  here?"   I 
said,  "Well,  I'm  going  down  to  the  lab.   I've  brought  some 
blood  in."  He  said,  "We've  got  a  break!   This  is  no  time  to  be 
here.   Get  out!"  He  opened  the  door  and  sort  of  booted  me  out. 
I  was  just  on  the  verge  of  going  into  the  corridors. 

When  you  review  it,  you  discover  that  the  breaks  are 
terrible  times.   Many  prisoners  don't  get  to  go  who  were 
planning  to  go,  and  they're  furious.   They've  lost  their  cool. 
They  go  quite  berserk  sometimes.   Others  become  berserk  under 
the  pressure  of  going.   None  of  the  guards  inside  the  prison 
were  armed,  in  this  prison.   I  mean  never,  ever,  ever—because 
you  could  have  the  arms  removed  from  you  and  then  you'd  be  at 
the  mercy  of  these  people. 

What  were  the  crimes  of  these  men? 

Oh,  all  kinds  —  from  the  most  desperate  to  the  mild— but  it  was 
a  short-term  penitentiary,  the  logic  being  that  even  if  one  was 
a  desperate  criminal,  if  he's  only  got  six  or  twelve  months  to 
go,  he  won't  get  violent.   The  majority  were  there  for  more 
modest  crimes— prostitution,  drugs,  homosexuals  from  the  armed 
forces— all  sorts  of  neat  people  in  there.   Some  of  them  were 
Jehovah's  Witnesses,  who  were  conscientious  objectors— some  of 
the  nicest  people  you'd  ever  meet.   It  takes  more  guts  to  be  a 
conscientious  objector,  let  me  tell  you,  than  to  fight  in  the 
armed  forces. 

During  the  break  about  twenty  or  thirty  men  got  out,  cut 
the  fences  and  everything,  and  ended  up  camping  along  the 
Wabash  in  the  trees  at  nightfall.   Some  of  them  stayed  up  in 
the  trees  for  a  couple  of  days.   The  guards  who  lit  campfires 
and  camped  under  the  trees  didn't  even  know  that.   They  finally 
were  all  caught,  and  they  brought  them  all  back.   It  was  really 
a  revelation  as  to  how  other  people  live,  and  then  to  discover 
that  many  of  the  people  were  just  poor  souls  who  had  had  a 
still  in  the  Ozark  mountains,  while  others  were  pimps  from 
Chicago. 


88 


Crawford: 
Blum: 


Crawford: 


I'll  never  forget  old  Frank.   He  pushed  a  broom.   He  was  a 
pimp  from  Chicago.   It  was  his  third  or  fourth  time  in  the 
penitentiary.   I  said,  "Frank,  what  the  hell  are  you  doing? 
You've  got  to  be  crazy  to  live  your  life  this  way.   Why  don't 
you  do  something  else?"  He  said,  "I  don't  know  how  to  do 
anything."   I  say,  "Yes,  but  this  crime  life  is  for  the  birds. 
Here,  you're  pushing  a  broom  in  the  penitentiary."  He  said, 
"Doc,  look,  I  won't  make  these  mistakes  the  next  time."  He  was 
learning  all  sorts  of  things  here  at  the  penitentiary. 

Then  as  you  get  into  it  further,  you  discovered  that  the 
judge  who  sentenced  him  also  owned  the  house  of  prostitution 
where  Frank  worked.   Just  a  small  reminder  of  how  things  are 
really  run.   And  that  Frank  had  paid  off  all  the  cops.   This 
was  his  world,  and  crime  does  pay.   There  were  all  these  nice, 
honest  people  out  there,  and  he  was  going  to  do  it  differently 
the  next  time  so  he  wouldn't  be  back. 

I'll  never  forget  the  story  I  heard  when  I  first  got  there. 
The  penitentiary  had  opened  up  the  year  before,  and  on  the 
other  side  of  the  Wabash  was  the  ghetto  for  Terre  Haute.   It 
was  across  the  Wabash  in  a  different  state,  Illinois.   It  was 
notorious  for  criminals  and  little  gangsters,  and  living 
conditions  were  awful.   The  teachers  took  all  the  school  kids 
and  paraded  them  through  this  penitentiary  to  teach  them  that 
crime  doesn't  pay. 

Well,  this  penitentiary  had  paintings  on  the  walls  done  by 
the  inmates.   The  kids  saw  a  bakery  the  likes  of  which  they'd 
never  imag-ried.   They  smelled  food  that  they  never  would  get  to 
taste.   Then  the  cells  —  everything  was  concreted  down,  lights 
built  in,  wash  basin  built  in,  toilet  built  in,  bed  built  in 
with  a  steel  mattress  frame  and  sponge  rubber  six  inches  thick, 
all  spotless. 

That's  all  looking  pretty  good. 

They  converted  every  single  kid,  I'm  sure,  to  a  life  of  crime. 
They'd  never  seen  anything  this  nice.   [laughter]   I  mean,  the 
virtues  or  the  rewards  of  crime  were  pretty  good.   These  kids 
had  never  had  a  bed,  never  had  enough  food.   I  noticed  that  I 
gained  weight.   I  got  fat--I  just  ate  lunch  there.   There  were 
marvelous  meats,  pastries  and  breads.   It  was  a  real  revelation 
as  to  how  some  parts  of  the  country  lived  as  compared  to 
others.   The  prisoners  raised  all  the  food,  took  care  of  the 
plant,  did  all  the  work. 

Tell  me  about  the  paper  that  resulted  from  the  research, 
because  you  said  that  everybody  accepted  it  100  percent. 


89 


Blum:      Not  only  accepted  it  100  percent,  they  started  off  in  the  first 
paragraph  that  the  National  Research  Council  endorsed  this 
study. 

Crawford:   What  was  the  name  of  the  study,  by  the  way? 

Blum:      Well,  it  was  called  "Experimental  Gonococcal  Urethritis  in 
Human  Volunteers."   It  was  published  in  1946—January.1 


Applying  to  the  Regular  Corps  tit 


Blum:      In  the  early  spring  of  1944,  the  USPHS  was  giving  examinations 
for  the  regular  corps.   For  anyone  contemplating  a  career  in 
the  service,  there  was  no  choice  but  to  pass  the  two-day  exam. 
This  was  to  be  given  in  Chicago  so  Marian  and  I  took  the  train 
from  Terre  Haute  and  stayed  with  old  friends  from  Berkeley 
days.   Since  there  were  only  four  Jews  in  the  entire  regular 
corps,  all  well  known  in  academic  circles,  it  seemed  unlikely 
that  I  would  pass.   When  I  arrived,  all  the  other  candidates 
came  up  to  introduce  themselves  and  several  undertook  to  inform 
me  that  I  would  obviously  pass  since  Jews  never  got  through  the 
physical  exam  which  I  had  just  taken  in  order  to  qualify  for 
the  exam. 

We  had  a  patient  to  work  up  and  then  a  lot  of  questions  to 
answer.   I  have  no  idea  of  how  well  I  did,  but  it  was  no 
scintillating  performance. 

Came  the  last  half  day  and  we  got  down  to  serious 
discussions.   The  presiding  Assistant  Surgeon  General  who  was 
an  obvious  Southerner  whom  I  didn't  always  understand  wanted  to 
know  what  newspapers  I  was  reading.   I  told  him  PM,  which  was  a 
liberal  Marshall  Field  offspring.   He  wanted  to  know  how  I  felt 
about  their  position  to  do  away  with  the  poll  tax.   I  told  him 
that  it  was  unconstitutional  and  should  be  ended.   He  quite 
vociferously  assured  me  that  it  was  constitutional,  and  I  just 
as  vociferously  told  him  that  if  it  was,  it  shouldn't  be. 

I  was  well  aware  of  what  this  meant  to  my  career  in  the 
USPHS.   But  who  wanted  a  career  if  it  was  to  be  oriented  to 


'Mahoney,  J.D.,  C.  J.  Yen  Slyke,  J.  C.  Cutler  and  H.  L.  Blum. 
Experimental  gonococcal  urethritis  in  human  volunteers.   American  Journal 
of  Syphilis,  Gonorrhea,  and  Venereal  Disease  30:1,  1-39,  January  1946. 


90 


getting  along  with  political  Neanderthals?   I  didn't  pass  my 
exam  and  was  told  so  before  I  left  that  day.   Good  fortune 
takes  many  forms. 


A  Faculty  Position  at  Johns  Hopkins  University  Medical  School 
II 


Blum:      In  Terre  Haute,  I  got  a  telegram  telling  me  to  report  to  J.E. 
Moore,  M.D.,  Chief  of  Medicine  #1  service  at  Johns  Hopkins 
University  Medical  School. 


Blum:      Hopkins  was  the  place  to  go  for  venereal  disease  training  in 
the  United  States  —  in  the  world,  in  fact.   The  only  thing  is 
that  being  sent  to  Hopkins  was  always  kind  of  an  in- joke  in  the 
Public  Health  Service,  your  reward  for  being  a  good  fellow, 
which  one  in  a  hundred  USPHS  physicians  might  get.   I  figured 
that  one  of  my  buddies  or  classmates  sent  me  that  telegram,  and 
that  I'm  going  to  show  up  at  Hopkins  where  they've  never  heard 
of  me.   [laughs]   There  were  no  other  official  orders  for  me  in 
Terre  Haute,  just  this  telegram.   So  I  got  on  the  phone  and 
called  the  Assistant  Surgeon  General  in  D.C.  who  was  in  charge 
of  personnel,  and  I  said  to  him,  "Sir,  I  have  this  telegram 
telling  me  to  report  in  so  many  days  to  J.E.  Moore."   "Doctor," 
he  said,  "goddammit,  we  don't  send  these  telegrams  out  for  fun. 
Now  get  your  ass  over  there.   Show  up  when  we  said."   "Well, 
okay."   Now  that's  been  settled.   This  is  clearly  not  a  joke. 

So  Marian  and  I  took  a  train  to  Buffalo  and  came  down  the 
Hudson  to  New  York  City  on  ship.   Then  we  went  on  to  Baltimore. 
It  was  an  awful  city,  a  dreadful  city;  it's  better  now  in  some 
areas  —  and  reported  to  Hopkins,  and  sure  enough,  that's  where  I 
was  supposed  to  be;  but  I  had  not  been  sent  as  a  student.   I 
was  part  of  the  faculty  at  Johns  Hopkins.   This  was  a  wonderful 
break  because  one  can  work  there  forever  and  never  become 
faculty. 

Crawford:   You  didn't  apply  for  this? 

Blum:      No,  no.   This  was  just  duty.   The  reason  this  all  happened  was 
that  Hopkins  had  been  stripped  of  faculty.   The  services  had 
taken  a  whole  group  and  made  a  hospital  unit  for  Europe,  and 
another  whole  hospital  unit  went  out  to  the  South  Pacific. 
Then  they  drafted  everybody  else  that  could  walk.   All  of  a 
sudden  Hopkins  had  very  few  faculty  who  could  get  around- -a  lot 


91 


of  old  timers,  really  old  timers.   So  they  were  replacing  the 
doctors  who  had  been  drafted.   Don't  ask  how  they  got  me,  but 
they  did.  I  was  two  years  out  of  medical  school:  one  of  those 
years  as  an  intern,  and  another  year  as  a  kind  of  a  researcher 
on  that  terrible  project  in  Terre  Haute. 

Crawford:   How  do  you  think  they  did  get  you? 

Blum:      I  never  did  inquire,  and  I  certainly  couldn't  complain.   The 
only  thing  we  knew  was  that  I  was  still  earning  a  hundred 
eighty- five  dollars  a  month,  and  the  cheapest  hotel  room  that 
had  running  hot  and  cold  water  was  a  hundred  eighty-five 
dollars  a  month.   So  I  went  down  to  the  USD,  and  they  found  us 
an  apartment  out  on  the  Chesapeake  where  the  Martin  bomber 
workers  lived.   They  had  new  apartments  out  there,  and  we  got 
one.   We  had  an  hour  and  a  half  commute  each  way. 

Crawford:   Was  your  wife  with  you  all  this  time? 

Blum:      Oh,  yes.   Always. 

Crawford:   She  went  to  all  these  different  places? 

Blum:      Oh,  sure,  might  as  well.   That  was  quite  a  fabulous  experience 
for  us  kids  from  small-town  California.   I  learned  all  kinds  of 
things.   My  first  day  there  at  Hopkins,  they  said,  "Now,  you're 
going  to  be  on  the  book  at  one  o'clock.   You'd  better  eat  your 
lunch  early.   You  go  down  to  the  main  dining  room,"  and  they 
told  me  where  it  was.   "Book"  meant  that  I  was  going  to  see  all 
the  new  patients  that  come  into  Medicine  One,  and  anybody  who 
comes  to  Medicine  One  may  have  any  kind  of  disease,  but 
somewhere  in  their  history  there's  a  possibility  of  venereal 
disease  and  so  they  are  going  to  be  seen  here  first.   But  it 
was  straight  medicine,  internal  medicine.   We  really  saw  every 
conceivable  disease. 

So  I  got  down  to  the  dining  room,  a  vast  place—they  "ve 
since  changed  it- -where  everybody  ate.   Apparently  nurses  and 
residents  ate  there,  and  doctors,  and  senior  staff.   I  was 
there  early,  so  I  couldn't  tell  too  much  about  who  was  going  to 
sit  where.   I  looked  around.   I  thought,  "Well,  this  has  got 
the  makings  of  trouble  because  I'll  probably  sit  at  somebody's 
table,  who  knows?"  Nobody  had  told  me  and  there  was  no  one  to 
ask.   So  I  picked  out  this  huge  table—it  looked  like  a  bunch 
of  slobs  would  eat  there—because  it  was  right  next  to  the 
kitchen  with  the  big  swinging  doors;  not  a  very  comfortable 
spot.   The  least  likely  place  you  would  sit  at  if  it  were  up  to 
you.   So  I'm  sitting  there  and  approaching  the  end  of  my  meal 
around  noon  when  a  cute  little  old  man  comes  in  and  says,  "I'm 


92 


Dr.  Longcope."  Well,  this  is  one  of  the  world's  famous 
internists,  and  he  sits  down  at  the  table.   I've  got  this  lousy 
uniform  on  with  one  and  a  half  stripes.  Then  another  old  man 
comes  in  and  introduces  himself,  "I'm  Doctor  Parks."   Well, 
that's  the  most  famous  name  in  pediatrics  at  that  time  in  this 
country. 

Then  TeLinde  came  in,  who  was  Mr.  Gynecology.   Then  Eastman 
came  in,  Mr.  Obstetrics.   These  are  the  folks  who  wrote  all  the 
textbooks  that  I  studied  from.   So,  you  get  that  right  away. 
There  was  Walter  Dandy,  the  truly  famous  neurosurgeon.   Then 
there  was  Blalock,  the  cardiac  surgeon  who  did  the  first  big 
open-heart  transposed  artery  surgery.   These  are  the  gods  of 
medicine.   So  I'm  sitting  at  their  table.   [laughter] 

Crawford:   Well  placed. 

Blum:      Yes.   Very  auspicious.   And  all  these  people  were  nice  —  except 
Walter  Dandy,  who  was  a  little  insensitive.   Well,  then  there 
was  Rich,  the  pathologist,  and  I  don't  know  who  all  else.   It 
was  the  place  to  be  for  lunch,  I  tell  you.   So,  after  that, 
Parks  kind  of  walked  me  down  the  hall,  and  he  said,  "If  you're 
not  too  busy,"  he  said,  "why  don't  you  make  rounds  with  me  in 
the  morning?  We  make  rounds  at  eight  o'clock,  and  you'll  see 
all  the  babies  and  children."  He  was  being  real  nice,  you 
know.   He  knew  I'd  been  traumatized  by  this;  and  I  had  been. 
Every  once  in  a  while,  if  I  had  time  and  I'd  go  make  rounds 
with  Parks,  a  very  sweet  man. 

Crawford:   What  did  you  learn  from  him? 

Blum:      Well,  I  learned  a  little  bit  of  pediatrics.   It  turned  out  that 
a  classmate  of  mine  from  UCSF,  who  had  become  a  pediatrician, 
was  the  chief  resident  at  that  moment.   Training  was  speeded  up 
very  drastically  during  the  war  and  especially  at  Hopkins, 
because  there  weren't  many  people  left  there.   In  three  years 
from  the  day  we'd  graduated,  he  was  already  chief  resident.   He 
had  an  old  infection  of  the  bone,  osteomyelitis  —  a  nasty 
disease  before  there  were  good  drugs  to  treat  it,  and  even  now 
it  is  still  not  a  happy  thing;  and  he  couldn't  walk  very  much 
or  very  fast. 

So,  I'd  help  him  make  rounds—go  see  all  the  kids  and 
little  babies.   That  was  an  interesting  experience.   In  the 
basement,  they  had  all  kinds  of  kids  who  lived  there,  little 
deformed  children,  crippled  children,  and  kids  who  apparently 
weren't  going  to  leave  and  were  being  studied.   It  was  like  a 
hidden  zoo,  but  these  were  all  little  kids  living  there  at  the 
time,  and  being  cared  for,  and  Walt  Tasem,  until  recently  a 


93 


practitioner  in  Pasadena,  would  gather  them  all  together  and 
read  them  stories  every  evening.   It  was  beautiful. 

Crawford:   What  a  place  to  be. 

Blum:      Yes.  They  were  swarming  all  over  him  as  he  read  to  them.  This 
was  their  one  real  human  contact.   I'd  go  visit  Pediatrics 
whenever  I  could.   I  was  doing  a  lot  of  experiments  in  the  lab 
at  night,  and  so  oftentimes  I  was  available  at  night  to  go 
around  when  he  was  seeing  the  babies  before  they  kind  of  shut 
the  place  down  for  the  night. 

We  saw  a  lot  of  fantastic  illness.   One  night  a  little  kid 
came  in  and  we  couldn't  get  him  or  her  going—a  little  one, 
like  a  year  and  half.   So  we  called  for  the  resident  in 
neurosurgery,  not  Walter  Dandy,  but  the  chief  resident,  who'd 
been  there  for  perhaps  nine  years.   Residents  went  on  forever 
at  Hopkins.   His  name  was  O'Tannesack,  I  believe.   He  came  in  a 
matter  of  half  an  hour.   Often  the  residents  stall  you  off 
because  they're  trying  to  sleep.  This  was  probably  ten  o'clock 
at  night.   We  tell  him  about  the  case,  and  he  just  fell  asleep 
on  the  desk.   We  decided,  "The  child  has  survived  up  til  now. 
Let's  let  the  resident  sleep  for  fifteen  minutes,  and  he'll 
feel  better."  And  sure  enough,  in  fifteen  minutes,  we  woke  him 
up,  and  he  was  very  bright  and  ready  to  roll  again.   But  in  any 
event,  we  got  as  good  advice  as  you  could  get  anywhere  in  the 
world,  I'm  sure,  about  what  to  do  with  that  child. 

I  just  don't  remember  the  details  of  it  anymore,  but  I  do 
remember  us  telling  him,  "Boy,  you're  beat,  aren't  you?"   He 
said,  "Look,  I  make  rounds  every  six  hours  day  and  night  on  all 
the  patients  in  neurosurgery."  Every  six  hours,  day  and  night, 
he  said,  he'd  done  it  for  over  six  years.   This  is  what  you 
call  training.   This  was  about  midsummer  because  there  was  a 
tremendous  summer  storm,  I  remember.   We  had  to  go  and  close 
all  the  windows  because  the  water  was  splashing  in  on  the  kids. 
He  said,  "I  got  married  at  Christmas.   I  don't  even  know  where 
we  live.   I've  never  been  there." 

Crawford:   That's  rough,  isn't  it? 

Blum:      Yes.   That's  how  they  train  specialists  there,  you  know. 

So  it  was  quite  an  experience.   I  learned,  and  I  learned. 
It  was  the  best  place  in  the  world  for  me  to  be.   Not  only  were 
there  marvelously  experienced  people,  they  were  all  sharp  and 
fast.   I  also  learned  something  else.   Some  of  my  students 
turned  out  to  be  some  of  my  superiors  in  the  Public  Health 
Service,  and  I  told  you  about  the  one  from  Hot  Springs, 


Crawford: 
Blum: 


Crawford; 
Blum: 
Crawford: 
Blum: 


Arkansas,  who  went  on  to  be  Assistant  Surgeon  General.   Well, 
he  comes  in  with  his  three  stripes--he' s  one  of  my  students-- 
and  he  works  up  a  case  and  he  presents  it  to  me.   We  had  a  good 
time  because  we  were  really  old  friends;  and  so  I  learned  more 
from  him  than  he  ever  learned  from  me. 

David  Price. 

David  Price.   But  that  was  a  kind  of  reversal  of  roles.   Here  I 
was  faculty  and  he's  just  one  of  the  students.   They  sent  them 
there  for  special  training;  but  I  got  to  be  there  as  one  of  the 
trainers. 

Isn't  that  remarkable? 
It's  really  just  crazy. 
What  were  your  rounds  like? 

The  way  the  clinic  was  set  up,  I  didn't  make  regular  rounds  in 
the  hospital.   I  was  in  a  clinic  and  I  consulted  with  students. 
Everybody  who  worked  up  cases  had  somebody  they  had  to  consult 
with  unless  they  were  faculty  like  me.   When  I  wasn't 
consulting  I  would  have  my  own  cases  to  work  up,  and  nobody 
would  consult  with  me.   If  you  were  one  of  the  faculty,  you  did 
your  own  work.   But  the  students,  or  anybody  who  was  sent  there 
for  training,  had  to  consult  with  one  of  the  faculty.   The 
faculty  were  marvelously  knowledgeable  physicians. 

Crawford:   These  famous  doctors  at  Johns  Hopkins:  did  you  see  more  of  them? 

Blum:      Yes,  whenever  they  did  anything  significant.   I  was  there  when 
they  paraded  all  the  blue  babies--the  first  series  of  infants 
whose  abnormally  transposed  blood  vessels  were  restored 
surgically  so  that  the  mostly  unoxygenated  blood  which  was 
going  through  the  body  was  sent  to  the  lungs  as  in  normal 
people  and  the  oxygenated  blood  then  went  to  the  body.   These 
kids  are  blue  or  purple  because  they're  not  oxygenated 
properly.   Another  great  pediatrician  there,  Helen  Taussig,  who 
picked  out  the  kids  to  get  surgery,  was  really  deaf  and  yet  she 
had  to  listen  to  all  these  children's  chests.   She  listened  to 
all  this  and  figured  out  what  had  to  be  done.   Don't  ask  me  how 
she  did  it.   They  didn't  have  all  the  pictures  they  do  now  so 
you  can  see  where  everything  is.  We  had  a  parade  of  about 
twenty  of  these  kids,  and  Blalock  had  transposed  the  aorta  and 
the  pulmonary  artery.   Well,  that's  something,  moving  the  two 
main  vessels. 


Crawford:   I  had  no  idea. 


95 


Blum:      Oh,  it's  tremendous,  a  world-celebrated  kind  of  thing.   They 

held  an  open  house  in  the  big  auditorium  in  the  medical  school. 
Everybody  who  was  anybody  went  to  that.   That  was  the  deluxe 
Hopkins  touch.   I  mean,  at  UCSF,  they  happily  cut  one  another's 
throats  in  different  faculties.   At  Hopkins,  they  really  pull 
together.   So  everybody  was  there,  and  there  were  tears  shed. 
It  was  a  magnificent  event  to  see  these  kids  walk,  and  no 
longer  purple,  and  some  were  no  longer  kids,  they  had  survived 
longer  and  were  getting  about  quite  well.   They  had  been 
restored  to  life,  really;  and  there  was  Taussig,  bowing  this 
great  big  bow.   Blalock  was  kind  of  a  proud  guy--he  never 
really  deigned  to  notice  the  audience—but  there  it  was. 

When  I  worked  in  the  clinic,  people  would  commonly  have 
come  from  all  over  the  world  to  Hopkins.   It  was  quite  the 
place,  more  so  than  Mayo's  actually.   I  remember  once  we  had 
people  from  Buenos  Aires.   One  of  the  old-timers  said,  "How  did 
you  happen  to  come  here  to  Hopkins?"  The  patient  said,  "We 
were  referred  here  as  the  only  place  to  go,"  and  there  was  some 
truth  in  it,  but  what  they  heard  was,  "You  didn't  have  to  come 
here.   One  of  our  graduates  is  in  Buenos  Aires--here  is  his 
address . " 


Crawford: 

Blum: 

Crawford: 

Blum: 

Crawford; 
Blum: 


Really? 
there? 


They  would  have  referred  these  people  to  a  doctor 


Back  home,  to  an  alumnus  of  Hopkins. 

So  was  Johns  Hopkins  the  most  famous  clinic,  then? 

It  was  the  place,  yes.   Harvard  was  creeping  up  on  it,  for 
sure;  and  Mayo  always  had  been  good,  but  Hopkins  was  better, 
really.   It  was  the  Mecca.   It  was  called  the  Mecca. 

What  other  very  dramatic  things  were  happening? 

Oh,  well,  for  instance,  that  was  the  place  where,  as  far  as  I 
know,  they  made  the  vaccine  for  yellow  fever,  just  before  I  was 
there.   I  don't  know  if  you  remember,  but  tens  of  thousands  of 
soldiers  who  got  the  yellow  fever  vaccine  also  came  down  with 
hepatitis.   Hepatitis  was  not  yellow  fever.   It  was  good  old 
fashioned  hepatitis,  probably  B.   The  reason  that  happened  was 
that  the  virus  in  the  vaccine  was  weakened  with  immune  serum. 
To  make  immune  serum,  you  had  to  get  volunteers  and  inject  them 
with  the  yellow  fever  virus.   Well,  one  of  the  lab  people  that 
I  worked  with  as  I  was  doing  the  lab  experiments  was  a  nice 
spunky  gal,  who  volunteered  to  be  the  guinea  pig  to  make  the 
anti-yellow  fever  serum  which  would  then  be  put  in  with  the 
yellow  fever  vaccine,  and  neutralize  it,  so  it  would  remain  a 


96 


Blum: 


living  vaccine,  but  one  that  wasn't  going  to  cause  yellow 
fever.   She  got  hepatitis  while  they  were  doing  this.   She 
worked  in  the  lab  all  the  time,  which  is  a  good  place  to  get 
hepatitis.   So,  even  though  her  blood  was  diluted  out  a 
millionfold,  one  smidgen  of  her  blood  was  in  each  dose  of 
vaccine.   Just  that  much  is  what  caused  the  hepatitis.   It 
caused  something  like  eighty  thousand  cases. 

Crawford:   Caused  it? 

Blum:      Yes,  the  vaccine  was  good,  but  it  also  carried  hepatitis,  which 
nobody  understood  or  could  test  for  at  that  time. 

Crawford:   They  didn't  know  that  she  had  hepatitis? 

Blum:      Well,  they  didn't  know  that  that  made  any  difference.   That 

mishap  was  when  they  started  catching  on.   Those  were  still  the 
dark  ages  for  much  of  immunology. 

Crawford:   So  you  just  surmised  that,  but  nobody  charged  Johns  Hopkins 
with  it? 

Oh,  no.   Who  would  have  known  differently?   It  so  happens  that 
when  I  was  an  intern  in  San  Francisco  I  had  taken  care  of 
eighty  of  these  hepatitis  cases  who  were  in  the  Coast  Guard 
when  they  were  vaccinated  for  yellow  fever. 

Crawford:   These  people  had  been  vaccinated? 

Blum:      They  had  been  vaccinated,  and  they  were  troops  from  the 

Aleutians,  and  going  overseas  to  various  destinations  in  the 
Pacific  where  they  might  meet  yellow  fever. 

Crawford:   Was  that  a  bad  strain  of  hepatitis? 

Blum:      It  was  mean,  but  there  weren't  too  many  deaths.   Out  of  the 

eighty,  only  one  looked  like  he  was  going  to  die  from  the  acute 
disease.   If  it  really  was  hepatitis  B,  a  sizeable  fraction  or 
more  would  die  from  it,  sooner  or  later.   If  it  was  hepatitis 
C,  many  more  would  die.   In  those  days  we  couldn't  even  tell 
which  was  which,  didn't  even  know  of  the  many  varieties  of 
hepatitis.   If  it  was  hepatitis  A,  none  of  them  would  die.   One 
kid  that  I  took  care  of  specially—because  he  was  the  only  one 
that  looked  like  he  was  dying- -was  in  and  out  of  a  coma  for 
months.   Lo  and  behold,  the  last  I  heard  of  him—we  fought  to 
get  him  out  of  the  service  but  couldn't— he  was  doing  four 
hours  on  and  four  hours  off  marching  guard  duty  at  the  Coast 
Guard  in  San  Francisco.   If  you  want  to  bring  about  a  relapse, 


97 


this  would  be  a  great  way  of  doing  it.  We  couldn't  convince 
anybody.   They  said,  "He's  all  right."  So,  that's  that. 


Blum:      Although  medicine  at  Hopkins  was  probably  as  sophisticated  as 
anyplace  on  earth,  how  one  lived  in  Baltimore  was  not.   One  of 
my  early  patients  had  a  grim  flesh-eating  disease  girdling  his 
genitalia  and  starting  around  one  thigh.   Called  granuloma 
inguinale,  it  was  probably  more  a  product  of  lack  of  hygiene 
than  a  venereal  disease.   Fortunately,  it  responded  to  lots  of 
warm  water  sitz  baths.   The  lesion  was  a  horribly  malodorous 
one  and  victims  soon  made  themselves  known  when  they  entered  a 
waiting  room. 

I  had  a  nice  enough  male  with  the  condition,  carefully 
explained  the  soaks,  the  temperature,  and  sent  the  man  on  his 
way  to  return  in  a  few  days  .   When  he  came  back  I  knew  he  was 
there  from  the  odor  wafting  into  my  office.   I  called  him  in 
and  asked  him  about  the  sitz  baths.   He  responded,  "Doc,  I've 
got  to  level  with  you.   I  live  around  the  corner  from  here  in  a 
unit  with  eight  other  people.   There  is  no  running  water,  the 
toilet  is  a  communal  affair  out  in  the  centrally  located  back 
yard  shared  by  about  a  dozen  buildings  that  enclose  it.   To 
soak  myself  four  times  a  day  in  a  tub  of  warm  water  means  I 
have  to  get  a  tub,  take  over  the  living  room,  where  all  nine  of 
us  sleep  on  the  floor.   To  get  warm  water,  I  have  to  heat  it  on 
the  kerosene  heater  after  I  haul  the  water  up  from  the  back 
yard,  and  it's  hot  as  hell  in  the  room  now  without  using  the 
heater."  This  man  was  turned  over  to  the  most  effective  social 
service  unit  I  ever  saw  in  a  hospital  and  they  got  him 
relocated  so  he  could  have  warm  soaks.   It  became  pretty  clear 
that  medical  advice  by  itself  isn't  enough. 

Many  years  later  I  was  the  opening  speaker  at  the  National 
Social  Workers  Convention  being  held  in  San  Francisco.   I  was 
making  my  usual  thrust  about  what  was  most  important  to  health 
and  recounted  an  episode  from  Hopkins  that  pointed  up  the 
relationship  of  medical  care  to  other  social  needs.   I  had  come 
in  to  Hopkins  fairly  early  on  a  truly  cold  wintry  day  and  found 
the  grand  tunnel  which  connected  all  the  medical  buildings 
totally  jammed.   I  spotted  someone  in  a  white  coat  and  asked 
him  what  had  happened,  imagining  a  disaster  of  some  sort  had 
driven  all  these  people  to  the  hospital.   I  got  a  laconic,  "Oh, 
it's  really  cold."   I  immediately  understood  the  reality  that 
the  ghetto  neighbors  couldn't  afford  the  twenty-  five  cents  for 
a  gallon  of  kerosene  to  heat  their  house,  and  I  proceeded  to 
work  my  way  along  the  hall  to  our  building. 


98 


On  reconsidering  what  was  taking  place,  it  was  obvious  that 
for  lack  of  some  small  amount  of  money  for  fuel,  thousands  of 
persons  came  to  Hopkins  to  get  warm.   But  there  was  a  price, 
people  had  to  say  what  was  bothering  them  and  be  assigned  to 
the  appropriate  clinic.   A  clinic  workup  at  Hopkins  was  no 
casual  affair,  taking  student,  staff,  and  faculty  time  and 
facilities.   Basic  lab  work  was  always  done.   So,  on  such  a 
morning  hundreds  of  thousands  of  medical  dollars  were  spent  to 
offset  the  need  for  a  few  hundred  dollars  of  kerosene. 

But  that  isn't  all.   Patients  don't  tell  you  they  are  cold, 
they  think  of  something.   When  nothing  of  consequence 
eventuates,  the  patient  may  get  more  tests,  and  if  one  of  them 
shows  any  deviation,  they  will  get  a  referral  for  a  more 
elegant  and  costly  clinic  for  a  workup.   If  the  cold  spell 
lingers  on,  and  the  patient  is  persistent  but  seems  physically 
well  with  no  abnormal  tests,  he  or  she  might  well  end  up  in 
psychiatry.   I  untangled  just  such  a  case  that  had  been  sent  to 
a  mental  hospital  ultimately  and  it  took  our  social  workers 
days  to  get  her  out.   Thus  are  social  needs  converted  to 
medical  care. 

I  had  a  few  more  such  tales,  made  my  point  about  the  need 
to  look  at  people  in  a  more  comprehending,  comprehensive  way, 
and  asked  for  questions.   A  grey-haired  tiny  lady  rushed  to  the 
nearest  microphone  placed  in  the  aisle  for  questions  and 
started  in:  "I'm  a  social  worker  from  Hopkins."   I  was  sure  my 
goose  was  cooked  and  that  she  was  going  to  undo  my  good  work  in 
one  way  or  another.   "And,"  she  went  on,  "I  want  you  to  know 
that  now  we  have  exactly  the  same  problem  in  the  middle  of 
summer  because  in  the  hot  days  everyone  is  afraid  of  the 
riots." 

There  were  other  regional  differences  to  be  observed  about 
how  health  care  and  health  intersected.   On  my  second  day  in 
Baltimore,  I  took  charge  of  a  medical  ward  at  Baltimore  City 
Hospital  as  part  of  my  assignment  to  Hopkins.   Going  to  the 
dining  room  for  lunch  put  me  at  a  table  which  included  two 
newly  returned  interns  who  had  shared  a  month's  duty  relieving 
a  rural  practitioner  on  the  Eastern  Shore.   He  was  taking  his 
first  vacation  in  decades  and  asked  the  interns  to  share  the 
work  and  keep  all  the  income  they  generated.   They  were  full  of 
the  rural  practice  they  encountered  as  compared  to  what  they 
were  learning  in  Baltimore. 

Their  most  memorable  encounter  apparently  was  with  a 
youngster  from  a  rural  ghetto  who  had  crashed  through  a  window 
and  was  badly  sliced  up.   They  spent  hours  meticulously 
stitching  him  together  so  that  he  would  have  minimal 


99 


disfigurement.   When  they  got  done  and  were  admiring  their 
handiwork,  the  doctor's  nurse,  who  was  the  mayordomo  in  charge, 
explained  that  the  doctor  had  an  immutable  rule  of  charging  two 
dollars  a  stitch  and  that  the  bill  for  this  poor  family  would 
run  into  several  hundred  dollars,  which  they  could  never  pay 
and  thus  would  leave  the  doctor  and  the  family  in  a  bad 
relationship.   The  interns  debated  for  a  while  and  then  very 
carefully  removed  every  other  stitch. 

They  had  been  somewhat  afraid  of  the  rural  obstetrics 
aspect  of  this  busy  practice,  but  were  relieved  to  learn  that 
the  doctor  always  charged  fifty  dollars  per  delivery,  but  if 
the  people  chose  his  nurse  to  do  the  delivery,  it  only  cost 
them  thirty-five  dollars.   Essentially  no  one  ever  used  the 
doctor  as  a  result,  and  the  interns  were  home  free  as  they  had 
no  deliveries.   Lunch  was  over  and  my  tour  of  rural  general 
practice  in  Maryland  in  the  mid-forties  was  also  over. 

I* 

Blum:      One  more  story  about  that  time:  When  we  lived  out  on  the 

Chesapeake,  almost  everybody  in  our  building  was  classified  by 
us  as  hillbillies,  most  from  the  South,  many  with  college 
degrees.   There  was  one  family  we  were  close  to.   He  was  a  high 
school  principal  with  a  lovely  wife,  Edna  Mae,  who  went  around 
in  her  bra  when  it  was  hot--just  as  modest  and  sweet  as  you 
could  ever  want  to  see.   There  were  eight  apartments,  each  with 
a  refrigerator  and  no  stove,  but  we  had  a  couple  of  burners. 
As  I  mentioned,  I  was  earning  $185  a  month  as  a  first 
lieutenant,  and  that  was  the  rent  at  the  Hotel  Baltimore 
downtown,  so  the  USO  found  us  this  apartment,  a  part  of  the 
housing  for  the  work  force  at  the  Glen  L.  Martin  bomber  plant. 

A  month  or  so  after  we  were  there,  we  were  sitting  at 
breakfast  and  saw  this  tick  crawling  up  the  wall,  so  I  put  it 
in  a  bottle  and  took  it  to  Johns  Hopkins  for  inspection. 
Everybody  there  got  hysterics:  "That's  not  a  tick,  that's  a 
bedbug!"   [laughter]   Marian  was  a  social  worker  and  her 
district  was  around  Hopkins,  which  was  a  bedbug's  paradise  with 
all  that  poverty,  and  Marian  thought  she'd  brought  them  home. 
I  thought  I  might  have  gotten  them  at  Hopkins,  for  they  were 
not  unknown  on  the  wards. 

One  night  soon,  though,  the  place  was  crawling  with  them 
and  it  was  hot,  and  we  went  outside  to  sit  on  a  bench  to  decide 
on  suicide,  escape,  or  what.   There  were  some  schoolteachers 
from  next  door  sitting  outside.   We  found  out  they  had  the  same 
problem.   We  soon  asked  all  the  other  tenants  about  it,  and 
found  out  that  one  of  the  previous  tenants  who  had  no  spouse 


100 


Crawford: 
Blum: 


and  had  to  fend  for  her  kids  on  her  own  had  left  the  building, 
and  the  bedbugs  she  abandoned  in  her  apartment  had  gotten 
hungry  and  gone  searching  for  food.   [laughter] 

So  I  went  down  in  my  uniform  and  told  the  rental  service 
that  they  had  to  do  something  about  this.   But  where  we  were 
wasn't  in  the  city  of  Baltimore,  and  no  one  could  be  forced  to 
do  anything.   So  I  decided  to  refuse  to  pay  our  rent,  using  my 
status  as  an  officer,  and  that  made  a  difference  to  all  our 
neighbors  who  joined  in  the  boycott.   Within  a  day  or  two  the 
management  came  in  with  oil  sprayers  and  destroyed  everything 
we  had,  and  that  worked  for  about  an  hour.   Then  in  another 
week,  since  we  still  refused  to  pay  our  rent,  we  got  notice  to 
leave  so  they  could  fumigate  the  entire  building  with  cyanide. 
We  left  practically  in  our  bathing  suits  so  we  wouldn't  take 
bugs  out,  we  stayed  with  friends,  and  when  we  got  back  it  was 
like  a  morgue  —  there  were  dead  animals  and  bugs  all  over--yet 
it  was  a  new  building,  about  six  months  old!   Welcome  to  the 
subtropics. 

In  the  course  of  cleaning  out  our  building  they  had 
discovered  about  a  hundred  aborted  fetuses  in  jars.   Nobody 
accused  me,  but  it  didn't  look  good.   An  army  doctor  who  lived 
in  the  same  housing  told  me  he  had  left  his  name  with  the 
management  in  case  of  emergencies  and  he  said  he  had  been 
called  for  a  childbirth.   It  had  been  messy,  the  mother  was 
taken  to  the  hospital,  and  when  it  was  over  no  one  could  find 
the  born-alive  baby.   Well,  one  of  the  well-meaning  neighbors 
in  attendance  had  put  the  baby  in  the  refrigerator  to  get  it 
out  of  the  way,  as  the  mother  was  bleeding.   For  the  heartland 
of  civilization,  famed  for  the  School  of  Public  Health  and  for 
its  Department  of  Public  Health,  it  was  easy  to  see  that  public 
health  must  be  in  desperate  shape  elsewhere,  or  that  a  good 
publishing  record  needn't  be  based  on  accomplishments. 

You  left  Johns  Hopkins  when? 

The  war  was  nearly  over,  so  that  would  be  what?  Forty- five? 
Actually,  I  was  shipped  out  of  there  to  Hot  Springs,  Arkansas, 
for  a  few  months.   The  war  was  over  in  '45,  and  then  I  was  sent 
to  San  Diego  to  be  part  of  the  County  Health  Department.   They 
couldn't  get  people  for  public  health  jobs  that  early  in  the 
demobilization. 

The  U.S.  Public  Health  Service  assigned  people  to  all  kinds 
of  places.   I  was  assigned  to  the  San  Diego  Health  Department 
to  complete  my  tour  of  duty  before  I  would  be  decommissioned 
and  be  allowed  to  take  my  fellowship  at  Stanford.   San  Diego 


101 


had  a  fine  health  department.   It  was  a  wonderful  place  to 
work,  a  very  enlightened  kind  of  county/city  government. 


Assignment  to  San  Diego 


Blum:      There  were  all  these  prostitutes  —  that  was  a  huge  business  with 
the  air  force,  the  army,  the  navy  and  marines  based  in  San 
Diego.   San  Diego  was  hopping  all  the  time.   Most  of  these 
people  were  separated  from  their  usual  family  and  friends,  and 
therefore  from  any  restraints.   If  they  had  a  wife,  that  would 
be  the  exception,  and  that  was  not  an  issue.   So  the  exposures 
were  fierce,  and  the  rates  of  venereal  disease  were 
spectacular. 

Every  day  and  night  the  police  were  raiding,  raiding, 
raiding,  and  then  every  night  the  prostitutes  were  brought  into 
the  city  jail,  and  somebody  had  to  examine  them  for  venereal 
disease.   In  the  first  place,  just  looking  isn't  that 
convincing,  but  if  you  think  you  suspect  gonorrhea,  you  can  do 
slides.   As  far  as  syphilis  is  concerned,  you've  got  to  do 
blood  tests.   It  takes  a  day  or  two  to  get  a  result.   So 
somebody  had  to  go  down  there  and  examine  all  these  women,  and 
do  the  various  tests.   You  line  up  these  poor  ladies,  and  prop 
them  up  on  a  GYN  table,  and  do  the  exams,  take  specimens  as 
indicated.   And  there  are  several  other  venereal  diseases  that 
had  to  be  kept  in  mind.   We  didn't  know  about  chlamydia  in 
those  days. 

That  was  a  pretty  hectic  scene,  but  I  soon  discovered  by 
looking  at  the  blotter  in  the  jail  that  90  percent  of  the 
prostitutes  who  had  been  arrested  weren't  there.   If  there  were 
a  hundred  of  them  arrested  last  night,  you  might  see  ten  or 
fifteen.   So  it  was  kind  of  an  idle  gesture.   I  asked,  "What's 
happening  here?"   "Oh,  the  bail  bonds  people  have  released  them 
all."  They've  come  in  with  the  bail--a  few  hundred  dollars 
bail—and  the  prostitutes  forfeit  the  bail  and  go  back  where 
they  were  working.   That's  a  good  old-fashioned  way  of  handling 
problems  in  the  courts  and  in  the  jails. 

So  I  said  to  the  chief  of  police,  "You'll  have  to  do 
something  about  these  people  coming  in  here  with  venereal 
disease;  you're  not  keeping  them."   "Well,  we  don't  put  a  hold 
on  them  until  you  see  them."   I  said,  "But  then  they're  not 
here  to  be  seen.   What  are  we  going  to  do  about  it?"  They 
said,  "Nobody's  ever  been  able  to  do  anything  about  it."   I 
said,  "I  can  think  of  a  way.   You  don't  mind  if  I  put  a  cot 


102 


here  on  the  jail  patio  under  a  banana  tree?   I'll  spend  the 
night  here  and  examine  each  of  these  women  as  they're  brought 
in."  That  gave  them  something  to  think  about.   So  they  said, 
"You  don't  have  to  do  that,  Doctor,  that  would  be  too  much  to 
ask  of  you.  They'll  be  here  in  the  morning."  And  they  were. 

I  had  to  examine  armies  of  prostitutes.   Sometimes  you'd 
see  them,  and  they  were  black  and  the  next  time  they  were 
white.   You'd  say,  "How  can  this  be?  They  can't  be  turning 
different  colors?"  Well,  they  wanted  different  clientele  for 
the  night,  given  the  ship,  so  they  put  on  a  routine  of  being 
black  for  that  occasion. 

Crawford:   The  same  women? 

Blum:      The  same  women.   Oh  yes.   I  mean,  they  were  appealing  to 

different  customers.   Really  quite  beyond  belief,  what  you'd 
recover  from  the  vaginas  of  these  woman.   All  kinds  of  gadgetry 
that  the  males  were  using  and  lost.   It  was  quite  an  education. 
I  didn't  know  there  were  such  things.   This  work  wasn't  exactly 
exotic,  and  surely  not  erotic,  but  it  was  interesting. 

Crawford:  Did  you  ever  write  anything  about  that? 

Blum:  Oh,  lord,  no. 

Crawford:  Were  they  treated? 

Blum:  Of  course,  and  fast. 

Crawford:  In  the  jails? 

Blum:      Yes,  wherever.   It  was  a  rough,  a  rough  scene.   And  then  I 

remember,  the  armed  forces  wanted  us  to  go  down  and  treat  all 
the  prostitutes  in  Tijuana  because  the  troops  were  at  liberty 
for  one,  two,  three,  four  days,  or  just  even  for  a  night.   So, 
somehow  or  other,  we  got  roped  into  checking  prostitutes  in 
Tijuana. 

Crawford:   The  Mexican  authorities  wanted  that? 

Blum:      No,  they  didn't,  but  our  military  did,  and  business  is 
business.   These  armed  forces  people  leave  hundreds  of 
thousands  of  dollars,  and  maybe  millions,  in  the  course  of  a 
week.   So  no  one  in  Tijuana  was  going  to  interfere  with  that. 
We  finally  came  up  with  a  brilliant  idea.   I  don't  know  how 
good  it  was,  but  they  lined  the  prostitutes  up,  they  knew  who 
they  were,  and  we  gave  each  of  them  a  million  units  of 
penicillin.   And  that  was  that.   In  those  days  before 


103 


Crawford: 
Blum: 


Crawford: 
Blum: 


Crawford; 
Blum: 


Blum: 


resistance  to  penicillin  it  would  get  rid  of  their  gonorrhea 
and  would  get  rid  of  syphilis  as  well. 


Quickly. 

Quickly.   And  so  we  didn't  examine  them  at  all. 
routine:  we'd  go  down  once  a  week. 


We  had  a 


1  remember  when  I  was  at  Hopkins,  we  already  were  getting 
stories  from  Europe  about  the  Germans.   They  had  beautiful 
houses  of  prostitution  in  France,  and  checked  every  prostitute 
every  day,  and  did  this  and  did  that. 

The  French  did? 

No,  the  Germans.   Oh,  the  French,  that's  another  story--they 
did  nothing.   But  the  Germans  —  this  was  rest  and  recreation  for 
the  troops.   Yet  they  had  a  rate  of  venereal  disease  that  was 
spectacular.   You  can't  control  it  just  by  inspections  of 
prostitutes.   The  same  prostitute  will  service  maybe  fifty, 
eighty,  a  hundred  men  a  day.   So,  if  one  leaves  a  disease,  the 
next  one  picks  it  up.   The  prostitute  doesn't  have  to  be  an 
incubator.   She  can  just  carry  it  from  one  to  the  next.   Well, 
they  finally  dismantled  all  their  inspections  of  prostitutes. 
The  United  States  got  all  the  records  as  they  were  captured 
early.   They  established  a  new  rule:  if  a  soldier  got  venereal 
disease,  he  was  shipped  to  the  Eastern  front.   The  Western 
front  wasn't  hard  ball. 

Did  that  help? 

I  don't  know.   The  war  was  almost  over.   But  in  Tijuana  we 
wasted  no  time  on  inspections.   We  treated  according  to 
occupation,  e.g.,  prostitute. 

** 

Then  we  had  an  experience  with  smallpox.   Smallpox  kept  coming 
back  with  the  troops  off  and  on.   Here  I  was,  the  junior 
person.   So,  I  got  to  do  whatever  was  interesting  or  looked 
like  it  was  a  little  crazy,  a  little  dangerous.   We  get  a  call. 
There's  a  small  aircraft  carrier  coming  into  the  harbor--San 
Diego  is  a  big  naval  headquarters.   It's  been  at  sea  for  three 
years.   It's  coming  in  flying  the  yellow  jack--a  little 
international  flag  that  says,  "We  have  a  plague  aboard."   It 
could  be  smallpox,  it  could  be  yellow  fever,  it  could  be 
bubonic  plague.   This  carrier  was  not  allowed  to  dock  in  the 
Philippines.   It  wasn't  allowed  because  of  the  case  of 


104 


smallpox-- just  one  on  board.   It  wasn't  allowed  to  dock  in 
Hawaii,  and  they  came  to  San  Diego,  their  home  base. 

It's  not  up  to  the  navy  to  let  these  people  ashore.   It's 
up  to  the  local  health  department  to  make  the  decision  whether 
the  crew  can  come  off  or  not.   In  Hawaii  and  the  Philippines 
they  wouldn't  let  them  off.   "You  stay  right  on  and  go 
somewhere  else."  These  were  men  who've  been  at  sea  for  three 
years.   So  the  commanding  officer  starts  telling  us  what  to  do, 
as  they  usually  do,  but  we  didn't  pay  much  attention.   It's 
like,  "This  is  our  decision.   We  want  to  ask  you  a  lot  of 
questions,  but  don't  tell  us  what  to  do."  My  wife  is  sitting 
out  there  in  the  car,  waiting  for  me,  because  that  night  we 
have  to  go  to  a  meeting  way  up  in  the  mountains  to  explain  to 
people  something  about  polio.   It  was  one  of  those  places  you 
drove  for  two  hours  to  get  to. 

Crawford:   You  had  no  idea  what  you  were  going  to  find? 

Blum:      Sort  of.   So,  I  went  on  board,  and  here  is  the  most  classic 

picture  I've  ever  seen  of  a  case  of  smallpox.   The  fingernails 
are  coming  off,  his  skin  is  coming  off.   He's  going  to  survive, 
but  all  this  shedding  skin  is  contagious,  and  where  is  he 
berthed?  Well,  the  only  cool  place  in  the  ship,  the  sick  bay, 
is  in  the  center  of  the  ship,  and  here's  an  air  pipe  two  feet 
in  diameter  blowing  across  this  patient.   He's  under  the  blast, 
but  it's  moving  the  scabs  all  over  the  ship. 

[Interview  3:  February  3,  1997]  //# 

Blum:      The  patient  is  lying  under  the  major  air  vent  at  the  center  of 
the  ship  in  the  sick  bay.   He  was  put  there  to  keep  him  halfway 
comfortable  because  that  area  was  cooler  for  patients  when  they 
were  in  the  tropics  for  years  at  a  time.   So  all  of  his  crud 
and  scabs  were  carried  all  over  that  ship. 

I  went  to  talk  to  the  two  medical  officers,  who  were 
younger  than  I  was.   They  said,  well,  he  didn't  really  have 
smallpox.   It  was  probably  syphilis,  and  syphilis  does  give 
people  all  kinds  of  skin  diseases.   His  disease  converted  his 
blood  test  to  a  positive  for  syphilis--a  weak  positive—but 
smallpox  does  that.   Even  smallpox  vaccination  will  sometimes 
give  you  a  weak  test  for  syphilis.   So  they  were  praying  to  god 
for  syphilis,  and  they  said  it  couldn't  be  smallpox. 

They  were  navy  doctors.   They  had  just  gotten  out  of  school 
a  year  previously  and  there  they  were.   But  they  had  not  taken 
any  chances;  they  had  gotten  shipped  to  them  some  water  buffalo 
vaccine—the  strongest  smallpox  vaccine.   Apparently  the 


105 


smallpox  virus  grows  beautifully  on  the  water  buffalo;  and  they 
had  used  that  vaccine  to  immunize  everybody  on  the  ship  three 
times  against  smallpox,  just  in  case  it  wasn't  syphilis.   So 
you  can  tell  that  their  confidence  was  a  little  low  when  it 
came  to  saying  it  was  not  smallpox.   I  said,  "It  i,s_  smallpox  as 
far  as  I'm  concerned,  and  that's  the  end  of  that."   So  we 
negotiated  about  how  to  get  the  men  off  the  ship.   I  mean,  you 
can't  keep  them  forever  after  three  years.   There  were 
thousands  of  women  and  children  waiting  for  their  husbands 
right  there  on  that  dock.   The  patient  went  to  the  San  Diego 
naval  hospital. 

So  we  said,  "Okay,  a  third  of  them  off.   We'll  clean  them 
up,  and  they're  off."  And  they  get  two  weeks  leave.   So  we 
figured  out  how  to  best  clean  them  off.   Well,  that  isn't  what 
the  naval  officers  understood  that  we  negotiated.   They  thought 
we  had  negotiated  eight  hours  leave,  one-third  of  the  ship  off 
and  two-thirds  on.   Then  that  third  would  come  back  and  the 
others  would  go.   I  discovered  that  a  day  or  two  later.   We 
threw  up  our  hands  in  horror  because  men  were  coming  back  to 
the  ship  day  and  night,  and  the  clean-up  is  kind  of  a  scary 
j  oke  anyway . 

Crawford:   What  is  the  clean-up? 

Blum:      Well,  making  sure  that  they're  not  walking  out  with  any  scab 
material  on  them,  contaminated  clothes,  gear. 

Crawford:   But  they  could  be  carriers? 

Blum:  Yes.  They  themselves  are  not  sick,  and  as  they  were  immunized 
they  will  never  get  sick;  but  they  could  be  carrying  the  scabs 
from  the  disease  and  that  carries  the  virus. 

So  we  decided  to  start  sending  them  home  after  a  few  days. 
A  third  were  gone,  then  in  so  many  weeks  another  third  could  be 
gone.   In  the  meantime,  they  were  already  off  the  ship.   So  we 
immunized  all  San  Diego:  every  man,  woman,  and  child. 

Crawford:   How  many? 

Blum:      Hundreds  of  thousands.   Five,  six  hundred  thousand.   Probably, 
that  was  about  all  the  people  there  were  then.   I  don't 
remember  the  details. 

Crawford:   Was  there  a  public  health  scare? 

Blum:      We  decided  to  immunize.   It  turned  out  that  there  were  cases  in 
Seattle  coming  off  ships  where  just  the  blankets  were  infected. 


Crawford : 


Blum: 


106 


So  we  had  ample  ground  for,  "Here's  a  ship  with  smallpox."  All 
on  my  say-so.   It  was  kind  of  scary  to  use  such  authority,  and 
then  make  a  mess  of  it. 

The  alternative,  the  only  real  alternative  was  just  to 
quarantine  the  men? 

But  they  had  been  at  sea  for  three  years  and  they  didn't  need  a 
quarantine,  it's  the  ship  that's  the  problem.   They  were  on 
that  ship  and  supposing  the  wind  blew  a  few  more  scabs  around 
anyhow . 

So  we  made  it.   Some  of  these  people  went  across  the 
country  to  their  families.   Well,  that  was  the  end  of  it,  but 
at  the  time  of  the  ship  inspection  I  said  to  myself,  "I  think 
I'll  get  an  immunization  right  here  on  board  ship.   You  guys 
can  immunize  me."  One  only  gets  immunized  every  so  many  years, 
and  I  hadn't  had  any  for  a  couple  of  years.   So  they  immunized 
me  with  that  nice  water  buffalo  vaccine,  [laughter]  and  I 
vaccinated  my  wife  with  more  of  that  vaccine  right  in  our  car 
before  we  dashed  off  to  our  night  meeting. 

Where  did  they  find  that? 

Oh,  they  picked  the  vaccine  up  from  the  Philippines.   Somebody 
delivered  it  to  them. 

How  did  you  call  the  population  in? 

There  were  announcements  in  the  paper  that  there  was  a 
potential  for  smallpox.   Ships  were  coming  back.   People 
already  heard  about  cases  in  Seattle,  and  here  was  a  ship  with 
a  case  on  it. 


Crawford:   Quite  a  story. 

Blum:      Well,  the  life  of  a  health  officer  needn't  be  dull.   [laughs] 

Crawford:   Did  you  have  anything  else  as  critical  in  San  Diego  during  your 
time? 


Crawford: 
Blum: 

Crawford: 
Blum: 


Blum: 


Not  particularly. 


107 
Going  AWOL;  Back  Surgery  at  the  San  Francisco  Marine  Hospital 

Blum:      My  departure  from  San  Diego  had  a  special  personal  aspect.   My 
time  in  the  service  was  drawing  to  a  close  and  we  were  looking 
forward  to  Stanford.   At  that  point  I  had  a  recurrence  of  a 
herniated  intervertebral  disc  (my  first  had  been  in  my  second 
year  of  medical  school  and  had  slowly  cooled  down  over  the 
years,  leaving  me  in  good  physical  condition). 

Nothing  seemed  to  help  the  back  and  leg  pain.   Since  I  was 
entitled  to  care  at  the  tremendous  Naval  Hospital  in  San  Diego 
(at  the  edge  of  lush  Balboa  Park  and  with  broad  ocean  views  as 
well),  I  turned  in  and  found  myself  in  a  quiet  junior  officers 
wing.   I  didn't  know  it  then,  it  only  came  out  later  that  the 
head  of  the  hospital  was  bucking  for  a  commodore's  rating, 
achievable  most  directly  by  increasing  the  numbers  of  patients 
at  the  hospital.   The  easiest  way  to  do  that  was  with  a  policy 
of  easy  admittance  and  difficult  discharge. 

After  four  days  of  pleasant  care  without  much  medical 
attention,  I  got  a  basic  exam.   Because  this  was  not  a  new 
condition,  one  that  in  fact  predated  my  entrance  into  the 
service  by  several  years,  I  was  told  that  I  could  get  no 
surgery  for  a  preexisting  condition,  but  that  I  should  remain 
in  the  hospital.   Since  my  condition  wasn't  changing  a  great 
deal  and  I  was  soon  to  begin  at  Stanford,  I  asked  for  a 
discharge.   Lo  and  behold,  I  was  not  fit  for  duty  and  therefore 
could  not  achieve  a  discharge  from  the  hospital  until  I  was. 
No  treatment  could  be  given,  nor  could  I  go  on  about  my 
affairs.   A  lifetime,  or  even  just  a  few  months  doing  nothing 
in  a  hospital  (no  rehab  or  exercises  were  offered  either)  would 
be  like  a  prison  sentence. 

We  called  some  friends  in  L.A.  who  had  a  car,  my  wife 
shipped  our  belongings  to  San  Francisco  for  storage,  and  on  one 
of  her  afternoon  visits  we  clumped  up  the  bedclothes  on  the  bed 
so  it  looked  like  I  was  asleep  and  got  me  dressed  up  for  a 
stroll. 

Marian  carried  a  few  parcels,  essentially  my  bedclothes,  we 
met  our  friends  at  their  car,  and  went  on  to  L.A.  where  we  had 
pullman  reservations  for  San  Francisco.   We  went  to  a  friend's 
house  in  San  Rafael.   I'm  still  AWOL,  no  doubt,  from  the  San 
Diego  Naval  Hospital. 

At  that  point  I  decided  to  begin  my  residency  at  Stanford. 
Took  the  bus  from  San  Rafael  and  completely  collapsed  with  back 
pain  when  I  got  to  San  Francisco.  We  had  gotten  an  apartment 


108 


by  then,  and  our  belongings  were  in  it.   I  lay  on  the  floor 
until  Marian  came  along,  got  an  ambulance  and  had  me  delivered 
to  the  Marine  Hospital.   Although  I  was  discharged  from  the 
service,  I  had  several  months  leave  coming,  and  the  USPHS  had 
no  problem  about  accepting  and  treating  me.   We  forgot  about 
the  San  Diego  Naval  Hospital. 

Crawford:   So  you  came  to  Stanford. 

Blum:      Yes,  but  let  me  backtrack  to  say  how  I  got  there.   When  the  war 
suddenly  looked  like  it  was  going  to  be  over.   I  was  in  San 
Francisco  on  V-E  Day,  I  went  over  to  UCSF  to  see  about  further 
training.   The  chief  of  medicine  was  a  windbag  and  when  I  got 
to  his  office  I  could  hear  him  gossiping.   His  secretary  said  I 
could  see  him  in  a  week,  that  it  was  tough  that  my  furlough 
would  be  up  before  then.   So  I  went  over  to  Stanford.   Had 
never  been  there  before. 


Blum:      I  came  to  the  reception  area  for  the  medical  school  and  asked 
to  see  Dr.  Bloomfield,  one  of  the  celebrated  internists  in  the 
U.S.,  and  certainly  the  dean  of  them  all  on  the  West  Coast. 
The  receptionist  got  him  on  the  phone  and  he  told  her  to  send 
me  up  to  his  office.   I  got  up  to  the  fifth  floor  of  the 
horrible  old  building  in  which  the  medical  school  was  housed, 
but  couldn't  find  his  office,  only  a  door  marked  fire  escape. 
So  I  went  back  down  to  the  receptionist  and  asked  her  to  call 
him  and  tell  him  I  was  starting  again  because  I  had  gotten 
lost. 

She  said,  "He  says  to  stay  here,  he'll  come  to  get  you." 
He  did,  and  his  office  was  behind  the  door  marked  fire  escape. 

He  found  out  what  I  wanted,  more  training  in  internal 
medicine.   He  asked  me  to  get  a  letter  from  my  chief  at  Hopkins 
who  had  been  a  fellow  resident  with  Bloomfield  at  Hopkins. 
J.  E.  Moore  sent  off  a  letter  when  I  got  back  to  Baltimore, 
Bloomfield  accepted  me  that  same  week  and  awarded  me  a 
Rockefeller  research  grant  as  well. 

I  had  become  a  Stanford  person  for  life  when  Bloomfield 
came  downstairs  to  fetch  me,  a  person  totally  unknown  to  him  or 
to  anyone  else  for  that  matter.   And  I've  been  a  Stanford 
person  ever  since,  as  we  shall  see. 

II 

Crawford:   So  he  was  waiting  for  you? 


109 


Blum:      Yes.   I  got  the  recommendation  Bloomfield  asked  me  for,  and 
eventually  it  all  came  about,  the  residency  and  the 
Rockefeller,  and  I  found  myself  at  Stanford. 

Crawford:   Did  you  have  surgery  for  the  disc  problem? 

Blum:      Yes.   I  was  still  in  the  service  and  had  surgery  in  the  San 

Francisco  Marine  Hospital  and  got  an  infection.   If  it  hadn't 
been  for  penicillin,  I  probably  would  have  died.   I  got  an 
infection  between  two  vertebrae.   I  had  a  fever  of  a  hundred 
and  five,  a  hundred  and  six,  day  after  day.  My  doctors  really 
paid  no  attention  to  me  at  all;  but,  of  all  things,  the  head  of 
the  Marine  Hospital  in  San  Francisco  was  a  tough  old  curmudgeon 
named  Hollingsworth,  and  he  had  shaped  up  the  Marine  Hospital 
in  Stapleton--the  one  where  I  had  first  started  my  career  in 
the  VD  research  lab. 

He  took  over.   He  had  shaped  that  hospital  up  from  a 
disaster  area;  then  he  took  over  the  one  in  San  Francisco  about 
the  time  I  got  here,  and  it  too  had  become  a  disaster  area 
since  1  left  as  an  intern.   He  had  rounds  every  morning  at 
eight  o'clock;  and  every  morning  at  eight  o'clock,  if  a  doctor 
wasn't  there,  let  me  tell  you,  he'd  soon  hear  about  it. 
Doctors  and  everybody  had  to  show  up  unless  they  were  in 
surgery.   He  always  knew  more  about  the  cases  than  they  did. 
He  knew  more  about  medicine  than  they  did. 

This  was  a  grand  old  man.   He  discovered  me  with  this 
wonderful  fever,  just  lying  there.   No  one  was  doing  a 
goddamned  thing.   So  he  moved  me,  and  I  started  getting 
treatment.   Once  the  old  man  starts  looking  after  you,  you're 
going  to  be  looked  after,  you  know. 

Crawford:   So  he  took  you  under  his  wing? 

Blum:      Yes,  and  the  Stanford  people  who  knew  I  had  been  unable  to  come 
to  work  at  Stanford  started  coming  in  at  that  time.   They  may 
have  been  aware  of  the  fact  that  I  had  been  operated  on  by 
nobody  less  than  Stanford's  chief  of  neurosurgery . 

Crawford:   Who  was  that? 

Blum:      Lusignian.   He  was  a  well-known  neurosurgeon.   He  worked  in  the 
Marine  Hospital  as  a  consultant,  and  he  did  their  tricky 
neurosurgery. 


110 


V  RESIDENCY  AT  STANFORD  AND  ON  TO  HARVARD:  1946-1948 


Treating  and  Studying  Syphilis 


Blum:      At  Stanford  I  was  getting  the  training  a  resident  would  get 

even  though  I  got  a  good  bit  more  money  as  a  research  fellow. 
That  was  a  friendly  environment.   I've  never  seen  anything 
quite  that  friendly.   Hopkins  was  friendly,  but  Stanford  was 
more  so.   I'd  known  that  as  a  student  at  UCSF.   We  were 
students  side  by  side  at  County  Hospital  in  San  Francisco  in 
our  third  year.   The  Stanford  people  were  happy,  cheery  folks, 
and  we  were  always  a  bunch  of  disgruntled  bums.   They  laughed 
at  us.   They  used  to  kid  us  about  the  sad  sacks  we  were. 

Crawford:   What  was  the  difference? 
Blum:      How  students  were  treated. 
Crawford:   Was  it  a  matter  of  numbers? 

Blum:      No,  same  size  class,  but  there  was  a  different  attitude.   I 

remember  when  I  first  came  to  Stanford  and  I  had  a  fair  bit  of 
free  time.   I  got  into  all  kinds  of  things.   I  went  to  x-ray 
almost  every  day,  fluoroscopy,  to  learn  how  to  handle  a 
fluoroscope.   They  had,  probably,  the  number  one  x-ray  man  in 
the  world  there  at  the  time,  and  he  was  teaching  the  students 
in  small  groups. 

I  remember  one  x-ray  session.   There  was  Newell--a  famous, 
kindly  man—asking  the  students  questions  about  "why  are  we 
doing  this?"  and  "why  are  we  doing  the  fluoroscopy  this  way?" 
One  of  the  students  was  just  abysmal.   He  just  didn't  know 
anything.   It  was  kind  of  funny--or  sad.   Newell  finally  got  a 
little  exasperated,  but  he  wouldn't  be  mean.   He  finally  asked 
the  student  to  classify  the  foodstuf fs--they  were  looking  at 
the  gastrointestinal  tract.   The  student  came  up  with  animal, 
vegetable,  and  mineral.   It  sounded  like  kindergarten.   Poor 


Ill 


Newell  didn't  have  any  hair,  but  he  was  reaching  for  it.   The 
rest  of  the  students  were  shying  away  from  this  poor  victim,  a 
kid  who  drove  a  big,  beautiful  car.   He  was,  I  think,  bright 
enough;  just  not  interested  in  learning  anything. 

Finally,  Newell  said,  "So-and-so,  you're  going  to  be  a 
doctor  next  year.   How  can  you  pass  yourself  off  as  a  doctor 
and  be  this  ignorant?  You  can't  do  it.   You've  taken  on  some 
agreements  with  society  when  you're  a  doctor.   You  can't  go  out 
there  and  be  an  ignorant  bum."  That  was  a  bawling-out  at 
Stanford.   At  Cal,  we  were  used  to,  "Okay,  one  more  trick  like 
that,  and  you're  out."  That  was  a  different  world.   True,  this 
student  probably  should  have  been  out.   But  the  appeal  was  made 
to  his  better  side,  and  in  no  way  was  it  made  as  a  threat  to 
his  survival. 

Crawford:   Did  he  straighten  up? 

Blum:       I  don't  know  because  it  was  too  close  to  the  end  of  his 
training,  and  he  wasn't  one  of  my  students. 

Crawford:   What  was  your  duty? 

Blum:      As  a  resident,  I  was  supervising  students,  taking  care  of 

patients  primarily,  and  doing  research  because  I  was  a  research 
fellow  so  I  had  taken  on  a  research  project.   We  had  just  a 
wonderful  population  to  do  research  on.   It  was  a  project, 
again,  which  might  raise  some  ethical  hairs.   We  were  looking 
at  what  happened  to  patients  with  syphilis  —  clearly  proven 
syphilis  —  some  who  had  been  treated  satisfactorily,  and  some 
who  had  not.   There  were  many  who  had  not  taken  treatment  for 
one  reason  or  another. 

Crawford:   Why? 

Blum:      Sometimes  they  had  decided  not.   At  other  times,  they  had  had 
the  disease  for  years  and  years,  and  had  never  known  it.  The 
treatment  wasn't  without  its  dangers  and  miseries,  and  we  and 
the  patients  had  come  to  an  agreement  not  to  treat.   So  we  had 
the  chance  to  follow  and  study  these  people  at  some  length  over 
many  years.   The  people  who  had  not  had  adequate  therapy  did 
have  more  than  their  share  of  ultimate  vascular  system  disease, 
nervous  system  disease,  and  so  on.   There's  just  no  question 
about  it.   That  study  was  one  of  my  major  publications.1 


'Blum,  H.L.,  and  C.  Barnett.   "Prognosis  in  Late  Latent  Syphilis." 
Archives  of  International  Medicine  82:393-409,  October  1948. 


112 


Crawford:   What  was  the  treatment? 

Blum:      Well,  it  depended  on  what  form  or  stage  of  syphilis  a  patient 
showed  up  with.   Penicillin  was  just  available,  but  the  older 
cases  had  all  gone  through  the  arsenic  or  arsenic  plus  bismuth 
treatment.   There  was  more  than  one  version  of  arsenic.   If  one 
had  ocular  damage,  which  was  not  rare,  one  was  treated  with 
another  kind  of  arsenic.   That  arsenic,  of  itself,  was 
dangerous  and  it  commonly  caused  loss  of  vision,  too. 

So  if  you  saw  the  patient  after  they  had  such  treatment 
with  bad  results,  you  saw  the  blank  nerve  heads  when  you  looked 
inside  the  eye,  yet  you  couldn't  tell  whether  it  was  due  to  the 
arsenic  or  the  disease.   That  was  tricky  therapy.   One  had  to 
know  a  lot  about  eyes.   One  also  [had  to  know]  a  lot  about 
heart  disease,  and  one  had  to  know  a  lot  about  other  nervous 
system  problems  if  one  was  going  to  treat  cases  of  syphilis. 

Syphilis  just  caused  all  kinds  of  hell--bone  disease, 
tumors,  all  kinds  of  unexpected  pathology.   The  tumors 
fortunately  would  dissolve  away  with  drug  therapy. 

So  that  was  the  research  project.   We  had  hundreds  and 
hundreds  of  patients:  treated  and  not  treated.   It  was  a 
respectable  study.   I  learned  something  about  research  methods 
at  that  point,  and  a  lot  more  about  internal  medicine  as  a 
practitioner. 

Crawford:   What  year  are  we  talking  about? 

Blum:      1946-47.   We  residents  in  medicine  had  a  small  journal  club- 
nothing  like  the  kind  we  had  at  Hopkins  where  the  whole 
department  came--but  this  was  just  the  residents.   There  were 
some  remarkable  people  amongst  those  Stanford  residents,  some 
of  whom  I'd  already  met,  one  of  whom  I'd  worked  with  at 
Hopkins.   We  were  a  fairly  diverse  group  of  about  a  dozen  who 
met  once  a  month  for  a  long  evening,  and  would  review  the  more 
interesting  journal  articles  that  we  had  found.   But  it  wasn't 
the  high-powered  operation  that  I  was  used  to  at  Hopkins,  where 
the  chief  of  the  service  was  there,  too,  which  kept  everybody 
on  their  toes. 


Crawford:   Is  that  East  Coast  versus  West  Coast  operations? 

Blum:      No,  it's  just  that  Hopkins  was  a  big,  ultra-scientific 

operation;  and  the  West  Coast  operations  were  poor,  piddly,  new 
little  places  by  comparison.  UCSF  and  Stanford,  in  those  days, 
were  not  very  much  by  Hopkins  standards.  They  had  a  few  famous 


113 


people,  each  of  them;  but  they  didn't  have  the  huge  faculties 
or  the  facilities,  equipment,  residents,  and  researches. 

Crawford:   And  the  clientele  was  different,  wasn't  it? 

Blum:      Well,  no.   It  was  primarily  desperately  poor  people  in  all 

these  university  settings.   In  addition,  well-off  and  famous 
people  came  because  they  were  referred  from  practitioners  for 
care  that  was  only  available  at  university  centers.   Very 
similar  in  that  sense  in  all  these  institutions,  the  wealthy 
got  care  on  the  private  wards,  the  poor  on  charity  wards. 

For  example,  when  I  was  at  Stanford,  Thomas  Addison  was  the 
chief  of  kidney  disease—world-famous,  the  best-known  name  in 
the  field.   When  he  got  sick  and  developed  a  serious  problem, 
he  went  out  in  the  wards  with  the  poor  people.   The  faculty 
hated  him  for  that.   [laughter]   He  was  an  old-time  liberal. 

Crawford:   You  would  have  done  the  same  thing. 

Blum:      Might  have.   It  wasn't  a  big  gesture,  but  it  was  certainly 
heartening  to  the  patients. 

Crawford:   Everybody  hated  him  for  that?  You  mean  the  staff. 

Blum:      The  staff,  yes.   "That  bastard,"  you  know,  "putting  on  a  show 

like  that."   But  he  probably  felt  that  this  is  where  he  got  the 
best  care.   The  residents,  who  did  most  of  the  care--some  on 
the  private  side  but  mostly  on  the  clinic  or  poverty  side—were 
the  same  residents,  but  they  probably  got  raked  over  the  coals 
harder  on  the  public  or  clinic  side;  because  there,  where 
chiefs  did  make  rounds,  they  didn't  hesitate  to  tell  the 
resident  that  they  didn't  do  this  right  or  that  right. 

The  clinic  patients  were  really  subjected  to  the  closest 
kind  of  scrutiny.   That's  where  the  medical  students  trained, 
that's  where  the  interns  and  the  residents  trained,  and  that's 
where  a  whole  retinue  of  big-shots  would  come  by  on  rounds, 
which  took  place  at  least  once  a  week,  and,  on  most  services, 
by  the  chief  once  a  day. 

So  there  was  the  feeling  that  there  might  be  some  risks 
there  from  more  mistakes  made  by  trainees,  but  overall  patients 
would  get  better  care. 

On  the  private  side,  the  physician  in  charge  of  the  case 
would  come  through,  and  he'd  trust  to  the  resident,  and  maybe 
there  wouldn't  even  be  any  interns  or  residents  on  the  private 


114 


side.   At  least  this  nephrologist ,  Addison,  made  it  clear  that 
he  thought  the  clinic  side  was  the  best  side. 

Crawford:   And  he  survived? 

Blum:      Oh,  he  survived.   I  think  that  he  wasn't  alone  in  his  thinking. 
A  lot  of  people  felt  that  the  clinic  side  did  very  well,  but  it 
is  true;  a  patient  there  was  exposed  to  more  novices.   It  might 
be  where  the  trainee  couldn't  hit  your  veins,  or  if  they  did  a 
spinal  tap,  they  would  spend  twice  as  long  getting  in. 

Trainees  also  go  home  and  crack  the  books  because  tomorrow 
when  they  make  rounds,  they've  got  to  know  everything  which 
might  set  a  new  light  on  the  case.   I  remember  about  the  first 
week  I  was  there  at  Stanford,  Bloomfield,  who  was  the  man  who 
brought  me  there,  was  the  grand  old  man  on  the  West  Coast  for 
internal  medicine.   He  made  rounds  on  the  clinic  patients  every 
Thursday.   Sometimes  a  hundred  or  more  doctors  would  be  there 
from  all  over  northern  California.   This  was  a  famous  event, 
making  Grand  Rounds  with  Bloomfield.   It  would  fill  up  a  whole 
ward  with  people  trying  to  see  or  just  even  hear  what  was  going 
on. 

Crawford:   What  was  that  like?  Describe  that. 

Blum:      Well,  he  was  an  older  man,  a  bit  bent,  very  scholarly-looking, 
bald-headed,  with  glasses.   The  patient  had  been  carefully 
worked  up  by  the  intern,  and  a  resident,  and  a  senior  resident, 
and  the  chief  resident,  you  know.   Then  god  knows  how  many 
other  physicians  had  seen  this  poor  patient.   This  was  on  the 
teaching  side,  the  clinic  side.   Bloomfield  would  ask  for  a 
recitation  from  some  of  these  people  to  tell  him  what  the  case 
was  about,  what  had  been  learned,  the  tests  and  their  results. 
Then  he  would  develop  the  data  and  go  to  the  heart  of  whatever 
the  critical  issue  was. 

It  was  never  a  simple  case.   He  didn't  bother  with  simple 
ones.   He  might  examine  the  patient.   He  was  not,  in  my 
opinion,  a  great  examiner.   He  wasn't  good  at  physical 
diagnosis,  I  didn't  think.   What  he  did  was  use  his  wits. 

When  he  heard  what  a  good  resident  had  found,  he'd  start 
putting  the  odds  together  very  scientifically,  as  though  he 
were  a  computer,  you  see.   He'd  say,  "Well,  this  kind  of  rules 
out  this,  and  this  kind  of  brings  this  in."  Even  though  he 
examined  the  patient,  that  wasn't  where  the  action  was  going 
on.   It  was  going  on  in  his  head,  and  his  diagnoses  were 
famous.   He'd  find  the  answers  in  a  real  haystack;  but  it 


115 


wasn't  because  he  saw  the  needle  by  looking  at  it  or  touching 
the  patient.   It  wasn't  that  kind  of  skill. 

The  first  time  I  went,  there  was  a  wonderful  and  famous 
European  radiologist,  Windholz,  in  attendance.   Stanford 
radiology  was  always  great,  and  this  man  was  a  refugee  who  had 
come  to  the  top  x-ray  department  in  the  U.S.A. 

II 

Blum:      It  was  Bloomfield's  show,  but  Windholz  was  also  a  prima  donna, 
and  a  superb  one.   As  they  went  through  a  case,  sometimes 
Bloomfield  would  turn  to  people  and  say,  "What  do  you  think?" 
if  it  might  concern  their  specialty.   Thus  he  could  get  more 
ideas  before  he'd  finally  pronounce;  and  I  don't  think  he 
called  on  Windholz.   Windholz  was  just  standing  by  the  bedside, 
though,  as  a  very  senior  man.   When  Bloomfield  got  all  through, 
Windholz  said,  "Did  you  look  at  the  patient's  neck,  Doctor?" 
And  here  were  these  great  big  old  tubercular  scars,  and  that 
was  the  key  to  the  case.   This  was  not  appreciated  at  all. 
[laughs] 

Crawford:   How  was  this  handled? 

Blum:      Well,  you  thank  goodness  that  the  good  Lord  sent  Windholz  to 
tell  you  what  the  answer  was,  but  if  the  chief  never  saw  him 
again,  it  would  be  too  soon.   The  next  time  we  made  Grand 
Rounds,  I  remember  Bloomfield  saying  to  him  something  to  the 
effect  of,  "I'll  call  upon  you  if  I  want  you."   [laughs] 

Crawford:   Keep  your  observations  to  yourself. 

Blum:      But  it  was  done  decently.   I  don't  think  anybody  snickered, 

except  maybe  a  few  of  us  residents.   Windholz  was  a  superb  man. 
I  remember  he  died  that  year.   All  of  a  sudden,  a  vicious 
cancer.   It  just  carried  him  away.   I  became  very  fond  of  him. 
We  had  encountered  patients  together,  and  I  was  one  of  the  few 
people  that  enjoyed  him,  his  brilliance,  his  remarkable 
experiences,  and  kept  visiting  him  as  he  was  dying  in  the 
hospital. 

Crawford:   Was  it  a  very  grueling  schedule? 

Blum:      I  didn't  think  so.   I  loved  it.   You  were  doing  what  you  should 
have  done,  and  that  is  a  careful  job  of  examining  patients, 
studying  medicine,  and  doing  your  research. 

They  didn't  have  anybody  there  to  do  cisternal  punctures  in 
the  clinics,  and  I'd  learned  how  to  do  that  somewhere  along  the 


116 


line—in  Arkansas,  no  less.   Sometimes  one  couldn't  get  spinal 
fluid  out  of  the  spinal  column.   Some  people  had  back  injuries 
so  bad  that  their  spine  was  all  messed  up,  and  one  couldn't 
find  a  place  to  go  in  to  get  to  the  spinal  fluid.   This  spinal 
tap  was  always  done  for  syphilitics  to  see  whether  their 
nervous  system  was  being  affected.   In  these  different  cases  I 
did  the  cisternal  punctures,  which  required  putting  in  a  long 
needle  at  the  base  of  the  brain,  to  get  spinal  fluid  to  test. 
That  was  quite  awesome  to  observers--!  was  glad  I  was  trained. 
I'd  be  scared  to  death  to  do  one  again. 

Crawford:   How  did  you  learn  that? 

Blum:      In  Arkansas,  just  by  watching.   You  watch  one,  and  then  you  do 
one.   [laughs]   How  else  can  you  do  it?  An  expert  is  sitting 
there  guiding  your  hand,  saying,  "No,  no.   Tilt  the  needle  this 
way,  or  that  way."  You're  pushing  the  needle  in,  and  you're 
waiting  for  a  feel  of  going  through  the  outer  lining,  which  is 
kind  of  the  tough  one;  and  then  the  inner  one,  which  is 
delicate  and  easy  to  go  through.   Then  you're  in.   Your  needle 
has  a  plug  in  it,  so  it  isn't  open.   You  pull  that  out,  and 
then  fluid  starts  coming,  and  there's  beautiful,  clear  fluid, 
and  you  capture  it  for  the  test. 

There's  a  limit  to  what  area  of  the  spinal  cord  you  want  to 
tap.   You  always  go  in  where  the  spinal  cord  has  ended,  to  the 
lower  three  or  four  inches  of  the  spinal  column.   In  a 
cisternal  tap,  you're  right  up  against  the  base  of  the  brain 
where  there  is  a  pool  of  spinal  fluid,  which  lends  itself  to 
tapping.   However,  I  heard  after  I  left  Hot  Springs  that  they 
had  stopped  doing  them.   I  said,  "Why?"  We  used  to  do  twenty, 
thirty  in  an  afternoon,  lined  up  the  patients  and  one  of  us 
would  get  there  and  do  them. 

Well,  two  patients  in  a  row  had  perished.   Somebody  was 
going  in  too  deep  and  hit  a  blood  vessel,  causing  a  hemorrhage 
at  the  base  of  the  brain.   Perhaps  if  there  were  a  good 
neurosurgeon,  I  think  they  could  have  done  something  about  it, 
but  they  didn't  have  any  neurosurgeons .   So  there  were  some 
drawbacks.   I'm  not  sorry  that  I  didn't  keep  on  doing  that  for 
a  living.   Anyway,  residents  had  moments  when  they  were 
obviously  smart  and  knew  how  to  do  something  that  nobody  else 
did.   Other  than  that,  it  was  just  a  high-quality  operation  and 
you  weren't  expected  to  do  heroics.   We  got  a  lot  of  referrals, 
but  the  bulk  of  the  clinic  patients  were  ours- -our  own 
patients,  and  we  proceeded  to  the  limits  of  our  skills,  which 
were  being  extended  by  with  every  new  case. 

Crawford:   And  you  lived  where? 


117 


Blum:      Oh,  ten,  twenty  blocks  from  the  hospital;  on  the  Mission  side, 
near  Mission  Dolores. 

Crawford:   Where  was  the  hospital  located  then? 

Blum:      Stanford?  Where  the  California  Pacific  Medical  Center  is  now. 

Crawford:   That's  what  I  thought,  but  that  was  a  long  walk. 

Blum:      I  didn't  walk.   The  streetcar  would  take  me  across  town.   I  may 
have  walked  home  sometimes  after  the  day  was  over.   That  was 
kind  of  fun.   A  former  classmate  of  mine  at  UC  was  living  right 
near  Stanford  and  was  a  resident  at  UCSF.   So  I'd  go  by  there 
and  see  him  and  his  wife  if  I  got  off  early.   He  and  I 
generally  compared  notes  about  what  we  were  learning  and  how 
life  was  treating  us.   He  didn't  get  his  promised  payments  at 
UCSF  after  all,  but  he  did  get  his  laundry  done.   That's  all  he 
got.   I  was  earning  real  money.   I  forget  what  it  was,  but  it 
was  over  two  hundred  dollars  a  month. 

We  would  trade  stories  about  our  residency.   I  was  so 
pleased  with  where  I  was,  and  the  people  that  were  around  me 
were  so  nice  to  us,  and  he  was  still  being  treated  like  dirt. 
He  became  a  very  fine  orthopedist. 

I'll  never  forget  one  day  he  said,  "You  won't  believe  what 
I  went  through  this  morning.   We  have  a  resident  who  put  the 
pictures  of  the  legs  of  a  patient  upside  down  in  the  viewing 
box."   He  said,  "You  know,  there's  nothing  wrong  with  putting 
them  upside  down,  but  whoever  studies  x-ray  pictures  upside 
down?"   [laughter]   He  said,  "I  can't  believe  it.   This  guy  is 
a  senior  resident,"  and  I  guessed  who  it  was.   He  said,  "How 
did  you  know?"   I  said,  "Well,  there  was  only  one  guy  that  lame 
in  my  class."  That  had  to  be  him. 

Crawford:   Well,  so  you  finished  your  residency  at  Stanford? 

Blum:      Yes,  and  then  it  was  a  matter  of,  "Where  do  I  go  from  here?" 
The  resident  that  I  had  met  at  Hopkins  during  the  war- -we 
worked  in  the  same  service- -was  leaving  Stanford  also.   We 
decided  that  maybe  we  would  go  into  practice  together  in  Palo 
Alto.   He  had  his  eyes  on  glory  and  wealth.   I  never  focused 
well  enough,  I  suppose.   So  we  thought  through  the  whole 
business  of  how  we  were  going  to  run  our  affairs  as  the  best- 
quality  practice  in  town.  Then  the  opportunity  came  for  me  to 
go  to  the  School  of  Public  Health  at  Harvard. 


118 


Harvard  University  and  the  School  of  Public  Health 


Crawford:   How  did  that  happen? 

Blum:      Well,  as  a  matter  of  fact,  while  I  was  exploring  the  Palo  Alto 
situation—and  we  would  both  get  teaching  appointments  at 
Stanford—life  looked  kind  of  rosy.   But  I  still  was  thinking 
about  living  in  the  East  Bay  and  opening  an  office  there 
because  we'd  spent  many  years  there.   So  I  went  to  see  a  man 
who  ran  the  clinics  for  what  was  then  the  Oakland  Health 
Department.   I  said,  "I'd  like  to  work  in  some  of  the  clinics." 
I'd  do  the  VD  clinics,  immunization  clinics--!  wasn't  going  to 
do  any  pediatrics  or  obstetrics.   I  was  exploring  the  options 
for  being  on  my  own  and  needed  income  while  I  built  up  a 
practice.   He  said,  "I'd  be  happy  to  put  you  to  work  in  the 
clinics.   We  can  find  a  place  for  you  so  you  could  start  a 
practice.   But  you've  done  this,  you've  done  that,  some  in 
public  health- -why  do  you  want  to  go  into  practice?  Why  don't 
you  go  into  public  health?"   I  said,  "I've  thought  of  it, 
really.   It's  kind  of  been  my  long-term  direction,  but,  then, 
on  the  other  hand,  this  past  year  all  I've  done  is  clinical 
medicine."  Well,  for  two  and  a  half  years,  really:  Hopkins  for 
a  year  and  a  half,  Stanford,  a  year.   "Why  don't  you  think 
about  it?"  he  said,  "I  went  to  Harvard  School  of  Public  Health, 
and  1  loved  it.   I  had  a  great  time  there,  and  I've  done  public 
health  ever  since,  and  never  regretted  it."  He  didn't  have  the 
internal  medicine  training  I  had,  but  he'd  been  trained  in  a 
general  way.   He  said,  "There  are  openings  coming  for 
physicians  at  your  level  who  will  be  paid  to  go  to  the  Harvard 
School  of  Public  Health  for  a  year.   You  can  earn  a  master's 
degree  in  public  health,  and  then  you  can  do  what  you  want. 
When  you  come  back,  you  can  still  go  into  practice,  if  you 
still  want  to,  but  you  could  also  go  into  public  health,  here 
or  elsewhere." 

That  was  the  fork  in  the  road.   I  had  to  make  up  my  mind. 
The  other  resident  said,  "Well,  I'm  going  to  Palo  Alto  to  set 
up  practice,  and  if  you're  not  coming  I'll  just  forget  about  it 
and  do  it  on  my  own."  And  he  did.   He  went  there  on  his  own, 
and  I  succumbed  to  the  lure  of  Harvard  and  public  health. 

I  had  an  interesting  year  there.   I  also  worked  in  the 
clinics  at  Peter  Bent  Brigham  with  internists  there,  and  had  a 
great  time.   They  were  very,  very  nice,  but  I  was  already 
clearly  a  physician  who  was  coming  back  for  a  year  at  Harvard 
School  of  Public  Health. 

Crawford:   What  did  you  get  out  of  Harvard? 


119 


Blum:      The  degree,  a  master  of  public  health,  in  1948. 
Crawford:   Yes,  but  what  hadn't  you  known? 

Blum:      Oh,  I  didn't  really  know  anything  about  public  health.   My 

exposure  to  public  health  as  public  health  was  a  bit  of  a  joke. 
I  had  prison  experience,  and  research  lab  experience,  and  this 
one  year  in  San  Diego  in  venereal  disease  control,  but  really 
never  learned  any  basic  public  health.   The  intern  year  in  the 
Marine  Hospital  was  all  medical  practice,  a  general  rotation 
from  ENT  to  OB/GYN.   But  the  stuff  I  got  the  most  of  was 
medicine.   Hopkins  was  all  medicine.   So  I  really  got  no  public 
health  training. 

At  Harvard  the  first  thing  I  discovered  was  that  I  had  a 
co-worker  from  Hopkins.   She  too  was  on  the  faculty  at  Hopkins 
when  I  was  there.   Her  name  was  Bowditch.   Well,  that's  a  great 
name  at  Harvard,  also  at  Berkeley.   She  was  a  lovely  person, 
not  married.   She  was  a  true  Boston  Brahmin  and  had  just  moved 
back  to  her  home  on  Beacon  Hill  the  same  year  that  I  ended  up 
there  as  a  student.   She  also  was  taking  a  master's  in  public 
health.   She  already  had  her  boards  in  internal  medicine.   At 
Hopkins  we'd  met  one  another,  but  here  we  became  closer  as 
classmates.   Faculty  wouldn't  let  either  of  us  take  a  couple  of 
courses  at  Harvard  School  of  Public  Health  because  the 
instructor  said,  "You  know  too  much  about  the  subject  matter, 
and  I  don't  want  to  put  up  with  that  sort  of  a  thing."  [laughs] 

Crawford:   What  was  the  course? 

Blum:      It  was  about  control  of  venereal  diseases. 

Crawford:   You  were  somewhat  of  a  reigning  master. 

Blum:      Well,  not  so  much.   I  knew  the  clinical  side,  but  not  the 

public  health  side.   The  professor  didn't  want  us  in  class. 

Harvard  was  a  great  place,  and  in  my  class  was  a  lady 
physician  who  ultimately  became  my  assistant  in  the  Health 
Department  in  Contra  Costa  County  for  maternal-child  health—a 
Japanese  lady,  a  fantastic  history,  Yoshiye  Togasaki.   She's 
still  alive.   She  was  a  bit  older  than  I.   She  was  from  a 
prominent  Japanese  family.   Her  father  was  a  minister- - 
Presbyterian  I  think—and  the  mother  was  one  of  the  first 
suffragettes  in  Japan. 

They  were  a  San  Francisco  family,  or  Berkeley /San 
Francisco,  and  had  quite  a  name  here.   One  of  her  brothers  was 
a  manager  or  president  of  the  Sumitomo  Bank  here,  and  another 


120 


one  was  the  manager  of  the  Nippon  Times  in  Tokyo.   This  was  a 
very  hardy  group  of  folks  who  had  had  all  kinds  of  advantages. 

My  classmate  had  gone  through  Cal  and  then  did  her  M.D.  at 
Hopkins.   She  was  subsequently  trained  in  pediatrics  at  USC  or 
UCLA  in  Los  Angeles.   When  the  war  came  along,  she  was  put  into 
one  of  the  Japanese  concentration  camps.   She  had  just  opened 
her  office  and  everything  she  owned  subsequently  disappeared. 

She  had  two  sisters  who  were  also  doctors.   One  was  known 
as  the  Angel  of  Buchanan  Street  in  San  Francisco.   She  was  an 
obstetrician.   The  third  sister  was,  I  think,  also  a 
pediatrician,  practiced  in  Hawaii  when  I  knew  her. 

Crawford:   That's  remarkable:  three  sisters. 

Blum:  Yes.  The  fourth  sister  was  the  head  of  nursing  at  a  huge  VA 
hospital  in  New  York.  These  were  fun  people.  I  got  to  know 
them  very  well. 

Yoshiye,  my  classmate  at  Harvard,  had  Boston  connections- 
she  lived  in  the  home  of  a  lady  who  was  a  Lowell  and  a  Cabot--! 
mean,  one  of  those  Beacon  Hill  families.   We  occasionally  went 
there  for  dinner.   These  were  old  homes  that  have  a  certain 
elegance  about  them,  so  we  thought  we  moved  in  good  company  in 
sort  of  a  second-hand  way. 

We  once  went  to  an  open  house  on  Beacon  Hill.   We  thought 
it  offered  one  way  of  seeing  how  other  people  lived.   We'd  seen 
two  such  homes  previously,  but  that  wasn't  very  much.   So  we 
paid--I  don't  know—six,  eight,  ten  dollars  to  feed  the 
starving  Bryn  Mawrians.   As  I  remember,  that's  what  the 
collection  was  for,  and  we  got  into  some  really  wonderful 
homes . 

In  one,  the  lady  came  to  the  door--a  brisk  lady,  striding 
in  fairly  short  skirts.   She  was  an  interesting,  pleasant- 
looking  woman—but  she  didn't  look  Bostonian.   She  began 
showing  us  around  the  place,  and  everything  about  it  seemed  out 
of  keeping.   We  were  with  another  person  on  this  tour  who  was  a 
San  Francisco  interior  decorator—one  of  the  first  gay  people 
that  I'd  really  ever  known.   We  became  rather  close  friends 
because  he  was  an  enjoyable  person.   "This  fireplace  we  redid," 
she  said,  and  he's  down  on  his  hands  and  knees,  feeling  it. 
Well,  they  had  painted  it  to  look  like  green  marble.   It  was  a 
fake. 

Crawford:   Marbleized. 


121 


Blum:      Yes!   This  is  an  old  Beacon  Hill  home.   A  showplace  on  Beacon 
Hill.   Next  we  go  out  in  the  backyard,  and  it's  one  of  those 
small  Beacon  Hill  backyards,  Louisburg  Square,  and  it's  just 
about  the  size  of  this  room,  maybe  a  little  deeper.   There  is 
almost  no  garden  there.   This  is  in  the  spring,  and  the  walls 
are  all  painted  in  azaleas  and  camellias.   [laughs]   It  turned 
out  our  hostess  was  from  out  West  and  she  was  just  having  a 
great  old  time  terrorizing  the  natives,  I'm  sure.   You  just 
don't  do  things  like  that  on  Beacon  Hill. 

Crawford:   She  made  a  reputation  for  herself. 

Blum:      Reputation  for  sure,  but  she  was  on  the  tour,  so  you  can 

imagine  her  status,  that  in  spite  of  all  the  monkey  business, 
she  was  on  the  tour.   Well,  that  was  part  of  going  to  the 
School  of  Public  Health.   We  didn't  kill  ourselves  there. 

Crawford:   Did  you  have  a  lot  of  statistics? 

Blum:  Yes,  a  beautiful  course.  That's  one  of  the  best  courses  I've 
ever  had.  I  really  learned  a  lot  of  statistics  there.  Or  do 
you  mean  statistics  about  the  school? 

Crawford:   No,  the  course. 

Blum:      Oh,  it  was  excellent.   It  had  always  been  superb,  and  it  still 
was.   They  didn't  waste  any  of  our  time  making  us  do  all  the 
mechanics  of  additions  and  subtractions  and  running  through  the 
statistical  formulae.   What  they  did  was  what  should  have  been 
done  at  any  other  school.   They  gave  us  a  series  of  articles 
that  were  out  of  the  best  journals  —  the  best  statistics  —  and 
they  said,  "Go  through  these  and  see  what's  right  and  see 
what's  wrong  about  the  premises,  the  methods  used,  the 
conclusions  drawn." 

One  learns  right  away  that  many  of  these  great  articles 
were  garbage.   The  way  they  assembled  the  numbers—well,  they 
weren't  the  right  headings  for  the  numbers,  or  the  researchers 
had  lumped  things  together  that  were  not  lumpable.   On  and  on 
and  on,  very  basic  stuff,  so  that  we  acquired  a  new  respect  for 
statistics,  and  even  if  we  weren't  going  to  be  statisticians, 
we  could  start  looking  critically  at  work  when  we  read  the 
literature. 


So  we  had  a  wonderful  program  in  statistics.   And  we  were 
left  to  study  what  we  wished.   That  was  the  beauty  of  Harvard. 
You  don't  have  to  do  something  because  it's  required.   If  you 
don't  need  it,  don't  do  it. 


122 


Crawford:   So  it  was  a  fruitful  year? 


A  Special  Bostonian  Family 


Blum:      Oh,  it  was  a  good  year  in  many  ways.   I  also  made  some 

remarkable  acquaintances.   We  couldn't  get  any  place  to  live 
initially.   It  was  right  after  the  war  was  over.   We'd  heard 
from  the  previous  class  about  a  medical  student  who  lived  in  a 
great  big  old  house  up  in  Brookline.   It  was  a  three-story 
mansion  built  by  some  old-time  gambler.   The  current  owner  does 
not  live  there  and  wants  to  rebuild  the  place  into  a  nice  home 
for  one  son,  and  has  another  house  she  will  rebuild  for  her 
second  son,  the  medical  student. 


Blum:      Currently  each  of  her  two  sons  has  one  floor  and  there  is  an 
attic- -a  huge  one  with  a  bathroom  that  has  been  let  to  SPH 
students  in  previous  years. 

The  student's  mother  owned  and  operated  a  big  clothing 
factory.   One  year  they'd  be  millionaires,  and  the  next  year 
they'd  be  broke;  a  fascinating,  big-city  Jewish  family.   When 
things  were  going  good,  she'd  send  a  thousand  blankets  to 
Israel  or  something  like  that. 

"She  just  doesn't  want  anybody  to  come  in  the  house,"  the 
medical  student  said.   "I'd  be  perfectly  happy  to  have  you.   I 
live  on  the  ground  floor,  and  my  older  brother  lives  in  the 
next  floor,  but  I  just  can't  do  it;  Mother  is  starting  to 
rebuild."   So  we  looked  and  looked  for  days,  and  we  finally 
came  back  and  rang  the  bell;  and  there  he  was  again.   School 
hadn't  started  yet.   He  was  still  in  his  bathrobe,  and  we  said, 
"Gosh,  can  we  just  stay  here  as  long  as  we  can,  until  the 
rebuilding  starts?  We  can't  find  a  place—nothing. "   "All 
right,"  he  said,  "all  right,  let's  find  my  mother."  And  he 
gave  her  a  story  about  these  poor,  starving  Calif ornians--he 
turns  out  to  be  a  real  character—and  they  have  no  place  to 
stay.   So  she  didn't  even  realize  she  was  going  to  get  rent 
from  us;  she  thought  she  was  putting  us  up,  that  appealed  to 
her. 

The  medical  student  son  was  quite  the  storyteller—a  real 
Danny  Kaye-- looked  like  him,  acted  like  him--a  tall,  gracious, 
handsome  fellow.   He  had  just  finished  his  first  year  medical 
school,  and  he  had  won  both  first  year  prizes  at  Harvard,  so 


123 


you  know  the  kind  of  character  he  was.   He'd  come  via  Purdue 
where  he'd  been  an  engineer,  summa  cum  laude. 

His  mother's  home  was  there  in  Brookline,  which  is  right 
next  to  the  medical  school,  and  he  thought,  "Maybe  with  my 
engineering,  I  should  go  into  orthopedics."  He  went  over  to 
Harvard,  and  talked  to  them  a  little  bit,  and  they  said,  "Well, 
why  don't  you  come  in  in  the  fall?"  None  of  this  crap  about 
have  you  had  biology,  and  haven't  you  had  Shakespeare--just 
another  world  from  Cal.   There's  a  difference.   They're  not 
number  two  and  trying  harder,  they're  number  one.   They  don't 
have  to  try  harder. 

He  came  in,  won  both  their  awards  for  freshmen  students. 
When  I  was  there  as  a  student  in  the  School  of  Public  Health, 
he  was  a  second-year  medical  student.   For  the  fun  of  it,  many 
nights  we'd  spend  hours  going  over  whatever  he  was  doing.   It 
kept  me  refreshed.   It  probably  didn't  do  him  much  good,  I 
don't  think  he  needed  much.   Well,  he  went  on  to  be  the  first 
Jewish  resident  in  surgery  in  Harvard. 

Crawford:   At  Harvard? 

Blum:      At  Harvard,  at  the  Mass.  General  Hospital.   He  was  something 
else.   His  name  is  Glimcher.   He's  chief  of  Orthopedics  at 
Harvard  today. 

Crawford:   Is  he  really?  How  do  you  spell  his  name? 

Blum:      G-L-I-M-C-H-E-R.   His  youngest  daughter  is  now  a  full  professor 
in  the  School  of  Public  Health  and  Medicine  in  immunology. 
They're  bright  people  —  and  fun  people.   Years  later  he  would 
come  out  here  for  the  orthopedic  meetings,  and  we'd  get 
together.   He  might  be  asked  to  do  a  four,  five,  or  six  hour 
session  on  all  the  new  information  for  the  nation's 
orthopedists. 

Crawford:   Still  head  of  the  department. 

Blum:      Still  going  strong,  yes.   He  did  some  fantastic  work  when  he 

finished  his  residency,  for  which  everybody  thought  he'd  get  a 
Nobel  Prize.   He  never  did,  but  I  do  remember  his  being  invited 
to  Russia  to  lecture  on  the  formation  of  bone,  which  was  the 
research  area.   He  learned  Russian  in  six  weeks  at  a  cram 
course,  and  he  gave  his  lectures  in  Russian. 

Crawford:   Oh,  that's  unbelievable. 


124 


Blum:      It  was  frightening:  tremendous,  rampant  brilliance.   [laughs] 
Plus,  he's  such  a  gracious,  determined,  handsome,  fun  person. 
I  remember  when  we  were  living  in  his  house  up  in  the  garret, 
which  we  converted  into  about  four  rooms,  including  a  bathroom 
with  an  ancient  old  copper  tub  which  had  the  seams  in  the 
bottom. 


Crawford; 
Blum: 


He  came  home  one  night.   He'd  gone  to  see  a  movie,  and  I 
don't  think  we  knew  about  it.   He  came  into  the  room,  and  we 
knew  exactly  what  it  was.   The  way  he  came  in,  he  was  the 
horses  prancing  on  Queen  Elizabeth's  coronation  carriage.   He 
could  convey  the  royalty,  the  horses,  the  carriage,  the 
ceremony  of  her  procession.   He  was  another  Danny  Kaye. 

That  was  quite  a  household.   His  older  brother  wanted  to  be 
a  doctor,  and  was  a  tremendous  salesman.   He  worked  in  the 
factory  for  the  family.   If  ever  his  older  brother  felt 
depressed  or  ill--he  was  a  huge  man--he  got  into  his  hospital 
bed  and  we  knew  that  Norm  wasn't  feeling  good.   He  wouldn't  be 
in  his  regular  bed.   [laughs)   It  was  a  medicalized  household. 

They  took  care  of  us.   They  gave  us  overcoats,  and  they 
gave  us  clothes.   Here  were  these  poor  starvelings  from 
Calif ornia--we  were  kind  of  a  decoration—that '  s  us,  these  poor 
devils  from  California.   But  in  moments  of  reality,  they  knew 
quite  well  that  we  weren't  any  such  things,  just  students  at 
Harvard. 

Your  wife  enjoyed  this? 

She  got  a  kick  out  of  it,  yes.   It  was  fun.   It  was  great  fun. 

I  do  remember  we  had  this  horrible  car:  the  only  one  we 
could  get  at  the  end  of  the  war.   It  was  a  Hudson  we  bought  in 
San  Francisco.   It  was  cheap  enough,  but  it  was  a  piece  of  junk 
as  it  turned  out.   They  told  us,  "You  can't  go  over  thirty- five 
miles  an  hour  because  we  have  a  governor  on  it."   I  bought  it 
when  I  was  at  Stanford  as  soon  as  we  came  back  from  the 
service. 

After  we'd  gone  our  thousand  miles,  we  went  down  to  have 
them  take  off  the  governor.   They  told  us,  "Oh,  well,  there 
really  isn't  any  governor  on  it.   It  just  won't  go  more  than 
thirty-five  miles  an  hour."   [laughs]   We  got  it  back  to 
Boston,  and  getting  it  back  home  was  even  worse.   That  car  was 
truly  a  nightmare.   In  Boston  we  kept  it  parked  in  front  of  our 
house,  and  of  course  it  had  California  license  plates  on  it-- 
and  to  see  the  kids  pet  the  car--I  never  got  over  that. 
California  had  that  kind  of  magic  about  it. 


125 


Crawford:   Oh,  it  was  California  that  did  it. 

Blum:      The  California  license.   They  were  petting  this  horrible  old 
Hudson. 

Crawford:   What  was  special  about  California? 

Blum:      Well,  it  was  the  dream.   It  was  the  Golden  State.   It  wasn't 

just  the  Chinese  that  called  it  Gold  Mountain.  It  was  kids  in 
Boston.  Your  car  would  not  be  damaged.  Kids  would  come  along 
and  gently  stroke  it. 

Crawford:   And  did  you  experience  that  too? 

Blum:      Yes.   We  were  from  California,  and  that  didn't  do  any  harm. 
Getting  our  attic  was  just  such  a  fallout. 

Crawford:   It  sounds  like  a  wonderful  time. 


126 


VI   SETTLING  IN  CALIFORNIA- -CONTRA  COSTA  COUNTY:  1950-1966 


The  California  State  Health  Department;  A  Year  in  San  Diego, 
and  on  to  Contra  Costa  County 


Blum:      When  I  came  out  of  the  Harvard  School  of  Public  Health  in  1948, 
I  worked  in  the  State  of  California  Health  Department  for  a  few 
weeks  because  they  had  sponsored  me  at  Harvard.   They  sent  me 
around  the  state  doing  odd  jobs.   I  ran  the  health  department 
in  Tulare  County  for  three  weeks  while  the  health  officer  took 
a  breather.   Then  I  went  to  San  Mateo  County.   They  had  a 
health  officer,  but  not  an  assistant.   So  I  was  there  for  some 
weeks  as  an  assistant. 

Then  I  was  sent  to  a  meeting  of  all  the  health  departments 
in  California  down  in  Long  Beach.   I  came  in  late,  sat  down  in 
the  dark  next  to  Alex  Lesem,  the  health  officer  of  San  Diego 
County  for  whom  I'd  worked  when  I  had  been  in  the  service  two 
years  previously.   He  was  an  old  fidgety  man.   He's  fidgeting 
around,  and  he  leans  over  and  pulls  my  badge  about  to  see  who  I 
am.   He  says,  "What  are  you  doing  here?"   I  responded,  "I'm  in 
the  State  Health  Department,  returned  after  a  year  at  Harvard." 
He  said,  "Let's  not  waste  any  more  time.   Let's  you  come  down 
to  San  Diego  and  be  my  assistant.   I'm  retiring  in  two  years. 
Then  you  can  have  my  job."   So  I  went  out  and  told  my  wife 
about  it.   We  both  loved  San  Diego,  although  there  were  some 
problems  about  it.   We  knew  that  we  would  always  commute  from 
there  back  to  the  Bay  Area  to  see  friends  and  so  on. 

Crawford:   Her  family  is  here,  as  well? 

Blum:      Yes.   But,  in  short  order,  we  moved  back  to  San  Diego,  but  only 
for  another  year,  as  it  turned  out.   This  year  I  was  number 
three  person  in  the  department.   The  health  of f icer--this  old 
man  who  thought  I  was  such  a  good  guy,  and  his  current 
assistant  director,  an  Indian,  pure-blooded  American  Indian 


127 


from  Oklahoma,  well  trained  in  public  health- -and  myself, 
number  three.   It  was  a  big  health  department. 

For  the  fun  of  it,  on  the  way  home  back  from  Harvard,  I  got 
a  short  hair  cut,  which  I'd  never  had  before.   I  also  bought  a 
bow  tie  and  a  pair  of  suspenders  to  hoist  up  my  trousers.   It 
was  intended  to  be  kind  of  a  joke.   The  Indian  who  was  chief 
assistant  always  wore  bow  ties.   (He  had  also  gone  to  Harvard.) 
It  turned  out  that  the  old  man  hated  bow  ties;  just  couldn't 
stand  them.   I  guess  I  had  luck  enough  not  to  wear  the  bow  tie 
to  work  the  first  few  days.   He  said,  "Do  you  know?  That  chief 
assistant  of  mine  wears  bow  ties.   What  kind  of  a  pimp  is  that? 
The  only  people  I  ever  saw  wear  bow  ties  in  Indiana  were 
pimps."  He  had  grown  up  in  Terre  Haute.   [laughing] 
Fortunately,  I  was  not  wearing  my  bow  tie,  and  I  never  did  wear 
my  bow  tie  in  San  Diego. 

The  chief  assistant  realized  right  away  that  our  boss  was 
undercutting  him.   The  boss  turned  to  me  to  deliver  all  the 
messages  for  the  department,  and  I'd  have  to  go  back  to  the  man 
above  me  who  was  really  the  chief  assistant  health  officer  and 
let  him  know  what  was  going  on,  tell  him,  "The  old  man  wants 
this  or  wants  that."  We  got  along,  which  was  surprising 
because  there  I  was,  being  set  up  to  take  over  his  job. 

As  I  got  into  the  job  in  1949,  a  great  polio  epidemic  was 
underway  in  San  Diego.   Every  day  I'd  make  rounds  on  all  the 
cases  in  the  county  who  were  cared  for  on  the  isolation  ward  at 
County  hospital.   Although  this  wasn't  my  assignment,  I  took 
care  of  every  one  of  the  360-plus  cases  that  occurred.   We  did 
everything,  iron  lungs  and  all.   We  wrote  an  article  about 
everything  we  learned.1 

It  was  when  polio  was  just  unraveling.   Bill  Reeves,  now  my 
next-door  neighbor,  and  one  of  his  sidekicks  were  unraveling 
the  mysteries  of  why  our  people,  Americans,  tended  to  come  down 
with  polio  in  countries  where  there  didn't  seem  to  be  any  polio 
cases.   Well,  it  turned  out  that  countries  without  polio  really 
were  riddled  with  polio;  they  had  been  infected  in  infancy,  had 
passed  through  it,  and  were  immune.   Our  troops,  in  a  country 
that's  fairly  clean  like  the  United  States,  had  never  really 
been  exposed  to  polio,  and  so  as  adults  placed  in  backwards 
countries  they  were  getting  heavy  doses  of  polio  virus.   In  San 
Diego  we  backtracked  every  case  to  where  it  came  from,  where 


'Blum,  H.L.,  W.  Chiapella  and  A.W.  Lesem.   "The  1948  Epidemic  of 
Poliomyelitis  in  San  Diego  County,  California."   Stanford  Medical  Bulletin 
7:4,  169-179,  November  1949. 


128 


they  lived- -and  lo  and  behold,  the  bulk  of  these  cases  occurred 
in  new  San  Diego  neighborhoods.   San  Diego  was  rebuilt, 
practically,  during  the  war,  and  this  was  at  the  end  of  the 
war.   These  were  people  living  in  new  neighborhoods  that  didn't 
exist  before;  but  if  you  went  one  step  further  in  checking  on 
the  victims,  which  gives  you  an  idea  of  the  pitfalls  of 
research,  it  turned  out  these  were  typically  longtime  residents 
in  those  new  neighborhoods. 

The  new  neighborhoods  were  composed  mostly  of  migrants  from 
all  across  the  country—disrupted  people,  families,  and  kids. 
So  it  was  more  likely  to  be  members  of  old  families  who  had 
already  been  there  who  got  new  exposures,  and  the  new  ones  were 
really  not  at  as  much  risk  because  they  had  been  infected  early 
in  life.   At  the  same  time,  we  took  care  of  the  two  cases  from 
Tijuana.   Tijuana  was  a  tenth  the  size  of  San  Diego,  and  should 
have  had  at  least  thirty-six  cases,  and  they  had  two  cases. 
Tijuana's  a  destitute  place,  you  know,  poor  and  dirty, 
unsanitary. 


Crawford:   They  were  immune? 

Blum:      Yes.   But  the  two  kids  who 
wealthy  families.   They  had 
started  learning  kind  of  by 
care  of  the  cases—you  know 
respiratory  paralysis  cases 
got  three  hundred  and  some 
all  kinds  of  polio  that  you 
they  were  clearly  polio,  at 


got  sick  with  polio  came  from  very 
been  protected  too  long.   So  we 
accident.   I  learned  how  to  take 

,  used  respirators  for  the  severe 
We  did  everything.   When  you've 

cases,  you're  in  business.   We  saw 
never  read  about  in  books.   Yet 
the  middle  of  an  epidemic. 


It  turned  out  that,  before  the  year  was  over,  the  old  man 
put  in  his  bid  for  retirement,  and  the  county  opened  up  the 
exams  and  I  was  not  yet  qualified  for  his  job— plain  and 
simple.   I  didn't  have  enough  experience.   The  chief  assistant 
had  to  have  two  or  three  years.   I  didn't  have  it.   I  had  a 
master  of  public  health.   So  did  the  other  candidate,  also  from 
Harvard,  but  he  had  the  experience.   That  was  that.   So  he  got 
the  job,  and  we  were  all  happy. 

He  was  a  nice  person—never  held  the  boss1  favoritism 
against  me.   The  old  man  had  his  quirks.   The  new  director 
offered  me  his  old  job.   I'd  move  up  and  be  number- two  man 
under  him.   I  thought  about  that  for  a  while,  but  we  were 
getting  a  little  tired  of  San  Diego  because  our  life  was  up 
here.   It  was  kind  of  crazy,  and  San  Diego  is  not  an  easy  place 
to  get  into  things.   We  got  involved  with  a  little  theater,  and 
we  got  into  this  and  that,  but  organizations  wouldn't  look  at 
you  if  you  were  a  newcomer.   They  were  so  used  to  the  service 


129 


Crawford: 
Blum: 


people—in  and  out.   They  thought  they  were  wasting  their  time 
and  money  on  transients.  We  thought  we'd  settle  there  at  first 
and  so  we  started  joining.   In  the  long  run  they  did  waste 
their  efforts  on  us  when  we  decided  that  we  really  didn't  want 
to  stay  in  San  Diego.   It  was  beautiful,  but  not  for  us. 

Then  I  applied  for  jobs  —  for  the  one  in  San  Mateo  and  the 
one  in  Contra  Costa.   San  Mateo  was  being  the  assistant—chief 
assistant—and  Contra  Costa  was  being  the  health  officer.  The 
health  officer  in  San  Mateo  met  my  wife  in  the  parking  lot  one 
day  and  said,  "Where  are  you  going  to  live  when  you  come  here?" 
Because  he  knew  I  was  applying  for  the  job.   She  smiled,  and 
she  said  she  loved  the  Peninsula  and  would  be  happy  to  settle 
anywhere.   She  hadn't  picked  anything  out.   It  was  very  clear 
in  her  mind  that  he  was  saying,  "You'll  be  here  shortly."  Then 
he  picked  the  lowest-rated  doctor  on  the  exam  list,  dead  last. 
He  never  spoke  anywhere  about  anything  in  the  twenty  or  so 
years  he  was  in  the  job. 


What  do  you  mean,  never  spoke? 


He  went  to  meetings  and  we  never  heard  from  him.   He  had  worked 
with  the  health  officer  in  a  previous  job,  so  the  health 
officer  knew  perfectly  well  what  he  was  like.   To  take  a  risk 
on  me,  I  guess,  would  have  been  crazy,  but  to  go  through  that 
fraud  with  my  wife  was  kind  of  pathetic. 

The  head  of  the  school  of  public  health  here,  Chuck  Smith, 
was  a  world-famous  public  health  figure,  and  he  sat  on  the 
selection  committee  that  picked  out  the  people  to  go  to  San 
Mateo,  and  he  picked  me  as  number  one.   So  everybody  else  on 
the  committee  went  along  with  that- -number-one  candidate.   When 
I  didn't  get  San  Mateo,  at  the  same  time,  more  or  less,  they 
were  selecting  the  health  officer  for  Contra  Costa.   Dr.  Smith 
was  on  that  committee  too.   As  the  dean  of  the  SPH,  he  was 
everywhere.   He  was  quite  a  scientist  as  well  as  being  public 
service  oriented. 

So  he  picked  me  again  as  number  one  for  Contra  Costa.   That 
job  I  got.   They  didn't  need  as  much  experience,  they  weren't 
as  fussy  as  San  Diego.   It  was  a  kind  of  a  cow  county.   It  had, 
historically,  a  horrible  health  department.   I  was  told  that  if 
you  go  out  there,  you're  going  to  wipe  yourself  out.   You 
shouldn't  even  go.   If  you  take  the  job,  for  goodness  sakes, 
don't  make  any  moves.  Just  take  it  easy  because  the  same  man 
has  been  on  the  board  of  supervisors  for  over  forty  years,  and 
has  been  chairman  for  twenty-four;  and  he  doesn't  go  for  public 
health.   So  take  it  easy.   This  was  advice  from  the  state 
health  department. 


130 


Crawford:   Who  was  the  chair  of  the  board? 

Blum:      Billy  Buchanan.   He  was  a  stocky  old  Scots  fellow  who  ran  a 
grocery  store  up  in  Pittsburg:  a  straightforward,  straight- 
shooting  guy,  but  so  ancient.   He  didn't  believe  in  newfangled 
crap  like  public  health,  but  state  law  said  he  had  to  have  a 
health  department,  so  he  had  one.   He  ran  the  board  with  an 
iron  fist. 

Crawford:   The  board  of  supervisors? 

Blum:      Oh,  yes.   He  was  chairman  of  the  board.   So  I  got  picked.   One 
other  person  on  the  selection  committee  was  the  head  of 
personnel  for  Tidewater.   I  guess  that's  Tosco  now.   Tidewater 
was  a  big  oil  company.   The  county  administrator  was  also  on 
the  committee.   He  wasn't  the  administrator  then--he  was  the 
county  auditor,  sweet  lovely  man.   I  got  the  job,  and  I  came  to 
work  for  Contra  Costa  County,  and  I  wasn't  sorry.   I  was  sorry 
to  leave  San  Diego  in  some  ways.   It  was  so  beautiful.   We 
lived  near  the  water:  a  block  from  the  ocean.   The  climate  was 
out  of  this  world.   We  had  quite  a  love  affair  with  it  because 
our  last  station  in  the  Public  Health  Service  had  been  in  San 
Diego. 

Crawford:   So  you  had  some  connections? 

Blum:      Yes.   I  knew  everybody  there  in  the  health  department,  and 

finally  a  lot  of  other  people,  too.   Well,  not  a  lot,  but  some. 
We  really  loved  the  place,  but  it  wasn't  where  our  life  was-- 
all  of  our  friends  were  up  here. 


Serving  as  County  Health  Officer  in  Contra  Costa  County 


Blum:      I  came  to  Contra  Costa  and  could  find  no  place  to  stay.   (We 
ultimately  found  a  motel  with  a  vacancy  in  Lafayette  in 
February.)   Some  people  met  us  at  a  party.   They  were  just 
youngsters;  he  was  getting  a  degree  here  at  UCB.   They  said, 
"Why  don't  you  come  and  stay  with  us.   We  have  a  place  in 
Berkeley."   So  we  stayed  with  them,  and  that  was  really  funny. 
They  were  total  New  Yorkers,  and  they  had  picked  some  poison 
oak,  and  it  was  on  the  mantlepiece--beautiful  leaves,  you  know. 
They  were  always  having  these  outbreaks  of  horrible  skin 
disease,  and  it  was,  of  course,  poison  oak.   They  were  just 
keen,  lovely  people. 


131 


Crawford: 
Blum: 


Crawford: 

Blum: 


Crawford: 
Blum: 

Crawford; 
Blum: 


She  came  from  a  well-known  family,  and  he  from  not  so  well- 
known  family,  but  a  fun  character  who'd  fought  his  way  up 
Montecasino  for  a  year  in  World  War  II.   His  squad  lived  in 
tombs--hollowed-out  tombs--on  Montecasino--were  held  up  there 
for  the  best  part  of  a  year.   A  fantastic  sense  of  humor,  which 
I  guess  you'd  have  to  have,  if  you  lived  in  graves;  and  always 
watching  out  for  the  mailman  to  make  sure  you  wouldn't  shoot 
him.   He'd  bring  the  mail  every  couple  of  days  while  they  were 
lying  in  these  tombs  and  slowly  inching  their  way  up  the 
mountain.   A  tremendous  casualty  load. 

Finally,  I  can't  help  but  think  of  these  people  as  so  sweet 
because  they  housed  us,  and  that  started  us  off  right.   Then  we 
found  a  little  house.   Bishop's  Better  Bungled  Buildings,  as  I 
remember,  we  used  to  call  them. 

What  did  you  call  them? 

Bishop's  Better  Bungled  Buildings.   The  builder  had  some  sort 
of  B-B-B  moniker.   He  wasn't  very  good,  and  things  would  always 
go  wrong  in  these  little  places.   We  found  the  little  shack;  it 
was  fairly  new  and  on  the  main  drag  between  Martinez  and  Walnut 
Creek.   We  decided  to  live  in  Walnut  Creek,  and  the  office  was 
in  Martinez.   The  reason  for  it  was  pretty  straightforward.   As 
soon  as  I  came  to  Martinez,  I  discovered  that  I  was  going  to  be 
asked  to  join  the  Rotarians,  the  Kiwanians,  the  Lions,  every 
little  social  circle,  the  bridge  club.   I  just  couldn't  live 
that  way.   There's  no  way  I  could  socialize  and  enjoy  the 
prominent  citizens,  lawyers  and  doctors,  in  town.   That's  not 
living  to  me. 

In  Martinez? 

In  Martinez.   So  we  discovered  that  if  you  lived  in  fast- 
growing  Walnut  Creek,  you  belonged  to  nobody.   Walnut  Creek  was 
the  home  of  everybody  and  nobody.   Yes,  there  was  a  little 
ancient  inner  circle,  but  most  people  were  newcomers  and  had 
ties  elsewhere,  at  least  initially. 

Why  was  Martinez  so  social?   It  was,  I  guess,  the  county  seat? 

It  was  the  county  seat.   If  you  were  going  to  live  there  and 
had  an  income,  a  title,  so  on,  you  had  to  fit  in  to  a 
relatively  stable  little  town  with  a  life  of  its  own. 

You  didn't  like  all  that  socializing? 

Well,  the  people  were  small-town  people.   Some  of  them  became 
important  jurists,  but  they  were  not  our  kind  of  people.   We 


132 


Crawford: 

Blum: 


didn't  have  trouble  with  them,  you  know,  but  in  Walnut  Creek  we 
were  left  alone.   Since  we  worked  in  Martinez,  that  kind  of 
dismissed  us.   Walnut  Creek  was  full  of  strangers.   In  Walnut 
Creek,  we  were  in  a  crossroads.   Well,  it  wasn't  even  a 
crossroads.   It  was  a  dead-end  road.   Highway  24  dead-ended  in 
the  middle  of  town,  when  we  came  there.   Our  friends  were 
wherever  we  had  made  them,  and  of  course,  we  did  make  many  in 
Contra  Costa  County  and  many  in  Walnut  Creek. 

We  ended  up  living  very  much  in  Walnut  Creek,  and  that  was 
the  beginning  of,  probably,  our  most  fun  years,  in  many  ways. 
I  was  the  health  officer,  and  knew  from  nothing.   We  had  had 
two  years  in  San  Diego,  thank  god,  where  we  had  a  heavy 
exposure  to  all  kinds  of  situations.   We  had  the  international 
border,  we  had  the  navy,  we  had  the  aircraft  carriers,  we  had  a 
lot  of  Indians,  and  we  had  a  lot  of  problems.   So  in  a  sense  we 
were  a  lot  more  sophisticated  coming  from  there  where  they  had 
big  problems  all  the  time.   Contra  Costa  was  kind  of  a  suburban 
bedroom  community  then.   There  weren't  the  big  office  buildings 
that  are  out  there  now. 

There  was  the  strip  of  heavy  industry  all  along  the 
waterfront.   That  was  something  we  really  hadn't  dealt  with  in 
San  Diego.   Heavy  industry  really  called  the  shots,  you  know, 
very  much  so  because  they  were  staggered  along  the  waterfront 
and  they  were  in  almost  every  supervisor's  district  with  one 
exception.   Industry  had  plenty  to  say  and  had  something  to  do 
with  how  the  supervisors  voted. 

How  did  you  begin  in  Contra  Costa? 

We  were  welcomed  in  Contra  Costa  by  a  lady  with  whom  we  also 
became  close,  who  is  now  in  her  mid-eighties.   She  was  a  very 
regal-appearing  person  with  a  wonderful  hair-do,  a  good  robust 
figure,  and  well  dressed,  a  smart  person.   Then  she  was  in  her 
forties,  and  she  was  the  president  of  the  Tuberculosis 
Association.   It  was  the  big  voluntary  health  agency.   They 
decided  since  they  had  such  a  terrible  health  department  —  and 
they  did—they  were  going  to  do  something  about  the  new  era. 

She  didn't  know  me  from  the  man  in  the  moon,  but  she 
undertook  to  have  a  welcoming  party  for  the  new  health  officer. 
It  was  held  in  the  C  &  H  Auditorium,  Californian  and  Hawaiian 
sugar,  in  Crockett.   There  were  hundreds  of  people  there  and 
everybody  welcomed  me  and  my  wife,  like  we  were  closest  of 
buddies.   That's  how  we  started. 


Crawford:   Who  was  she? 


133 


Blum:      Helen  Vurek.   She  worked  in  the  post  office  in  Orinda,  and  knew 
everybody  that  lived  in  Orinda  because  she  was  the  mail  person 
there.   Her  husband  George  was  an  artist,  but  during  the 
Depression  he  turned  into  a  pattern  maker,  which  takes  good 
artistic  skills.   He  had  a  big  pattern-making  shop  in  San 
Francisco--the  kind  that  builds  propellers  for  ships  —  and  in 
his  spare  time  did  art  things.   He  was  that  kind  of  person  who 
could  do  things  accurately  to  the  nearest  thousandth  of  an  inch 
if  it  was  needed,  but  beautifully,  too—beautiful  work.   So 
they  had  a  good,  basic  business.   They  weren't  rich,  just 
basically  well  off.   They  had  a  son  who  was  just  starting 
Caltech  to  be  an  engineer.   He's  already  retired. 

We  were  suddenly  part  of  their  circle.   They  were  amongst 
the  most  gregarious  people  that  I  ever  met.   They  were  liberal 
people,  well  read,  even  though  neither  had  been  to  college. 
They  knew  more  than  most  college  people  that  I  knew;  they  were 
just  up  on  their  toes.   They  went  to  something  every  night:  a 
lecture,  a  play,  an  opera,  a  concert.   We  never  could  keep  up 
with  them.   They've  been  everyplace  in  the  world.   In  fact,  we 
just  had  dinner  with  Helen  a  night  ago;  George  died  about  two 
years  ago. 

So  we  were  thrust  into  a  kind  of  a  ready-built  group,  and 
most  of  them  were  similar  kinds  of  people.   A  Supreme  Court 
judge,  Ray  Peters,  was  one  of  their  old  intimates,  a  wonderful 
man.   I  don't  know  if  you  ever  heard  of  him,  but  he  was  one  of 
California's  great  Supreme  Court  judges.   Right  away,  we 
started  meeting  all  these  people.   These  are  your  friends,  you 
see.   That  was  kind  of  fun  because  I  think  we  could  have  met 
these  people  only  very,  very  slowly,  if  ever.   They  were  not 
just  Contra  Costans.   They  were  in  San  Francisco  and  the 
Peninsula.   They  were  in  Marin.   Their  folks  or  friends  were 
scattered  all  over--it  was  a  big  family. 

Crawford:   But  that  meant  the  community  valued  you  and  the  position  you 
were  taking? 

Blum:      Yes.   It  completely  changed  the  flavor.   The  previous  health 

officer  never  moved  a  finger.   I'll  never  forget  the  first  day 
I  came  to  the  office,  and  here's  the  director  of  nurses,  who 
was  a  great  gal—powerful,  big  Minnesota  lady— and  she  had  her 
feet  up  on  my  desk— she  denies  that  it  was  true— but  I  remember 
it.   It's  just  like  she  lived  there,  and  she  did,  too.   She  ran 
the  health  department  for  the  previous  guy.   There  wouldn't 
have  been  a  health  department  if  it  hadn't  been  for  her. 

Crawford:   What  was  his  name? 


134 


Blum:      I  don't  even  remember.   The  director  of  nurses  tells  me,  "We've 
got  a  big  clinic  tomorrow  morning,  and  you  have  to  give  shots." 
That  was  the  way  it  was  set  up--you  give  the  shots,  and  they 
prepare  everybody,  and  move  them  along.   So  I  said,  "What  do  we 
use  for  needles?"   "Well,  in  your  desk,  there  are  three 
platinum  needles.   And  that's  the  extent  of  the  stock  here,  and 
three  syringes  to  go  with  it."  They  were  going  to  do  a  clinic 
of  five  hundred  people.   I  was  kind  of  baffled;  I'd  never  seen 
anything  like  this.   She  said,  "Well,  that's  the  reason  they're 
platinum."   It's  that  you  can  put  them  in  a  flame  and  it 
doesn't  hurt  the  needles.   They  stay  sharp.   This  was 
sterilizing.   You  go  from  one  person  to  the  next.   Well,  that 
isn't  safe  sterilization  because  there's  often  pull-back  into  a 
syringe,  and  you  can  get  some  blood  or  a  little  plasma  from  one 
person  and  you  can  spread  it  to  a  thousand  more  by  using  the 
same  syringe.   Really,  it's  horrible. 

So  I  kind  of  shuddered,  and  I  proceeded.   We  went  to  the 
clinic,  and  I  got  them  to  take  along  a  few  ordinary  needles 
that  could  be  boiled  and  sterilized  on  the  spot,  although 
boiling  is  hell  on  their  sharpness.   I  didn't  wait  too  long 
until  I  completely  destroyed  those  three  needles.   They're  very 
delicate,  and  they  kind  of  crumpled  up  in  my  clumsy  hands.   So 
we  got  rid  of  the  three  needles.   We  didn't  ever  replace  those. 
In  the  next  day  we  bought  a  couple  thousand  needles  and 
syringes,  starting  to  do  business.   At  least  you  could  breathe. 
The  disposables  didn't  come  in  for  another  five  years. 


Expanding  the  Budget  and  the  Department:  Testing  for  TB 


Crawford:   What  was  your  budget  like? 

Blum:      Oh,  it  was  almost  zilch.   I  don't  know.   It  was  pennies.   It 

was  pitiful.   It  went  up  spectacularly  the  first  year.   One  of 
my  selection  examiners,  who  had  been  the  county  auditor,  had  at 
this  point  become  the  county  manager,  Desmond  Teeter  by  name, 
and  was  now  my  immediate  boss.   There  were  about  twenty 
candidates  for  the  job,  and  since  he  had  selected  me,  I  had  a 
buddy  in  the  right  spot.   He  was  a  nice  man,  a  lovely  man,  and 
inadvertently  he  gave  rise  to  this  medical  school  at  UCB--quite 
inadvertently—because  of  various  things  that  happened  out 
there.   What  a  small  world  this  is.   He  kept  going  to  the  board 
on  my  behalf.   I  got  there  February  the  first,  and  the  budget 
had  to  go  in  in  March  or  April.   In  those  days,  a  county  like 
that  finished  with  the  budget  in  July  or  August.   Our  health 


135 


department  budget  went  up  severalfold  over  the  year.   Billy 
Buchanan,  our  board  chair,  had  a  heart  attack  and  died. 

Crawford:   No! 

Blum:      No.   I  can't  blame  it  on  the  budget,  but  I  can't  be  sure  about 
that.   But  it  surely  happened.  And  in  this  turmoil,  and  with 
the  auditor  becoming  the  administrator  and  really  running  the 
county,  my  boss  was  this  kindly  older  man.   The  TB  Association 
wanted  to  do  a  TB  survey  of  the  citizenry  as  soon  as  I  got 
there.   Chest  x-ray  surveys  were  very  popular  then.   Everybody 
got  a  chest  x-ray.   I  had  just  been  in  charge  of  the  one  in 
San  Diego,  and,  lo  and  behold,  the  people  here  were  clamoring 
for  one. 

So  I  got  the  same  team  from  the  USPHS  that  we  had  in  San 
Diego  to  help  run  it.   I  got  the  same  crew  and  one  extra.   That 
was  Leonard  Duhl.   He  and  another  doctor  were  sent  here  by 
USPHS  to  read  the  x-rays.   That's  how  1  met  Len  Duhl.   The 
survey  went  so  easy  and  fast  that  he  would  spend  most  of  his 
time  working  and  doing  general  public  health,  not  just  reading 
x-rays.   He  was  here  for  two  years.   So  we  spent  a  lot  of  time 
together,  learning  about  public  health.   He  was  totally  free 
wheeling,  so  he  could  find  all  kinds  of  problems  and  approaches 
to  them. 


Blum:      All  of  a  sudden,  this  TB  thing  had  landed  on  us  and  we  x-rayed 
every  adult,  and  it's  a  tremendous  and  very  visible  campaign. 

Crawford:   Where  does  that  mandate  come  from? 

Blum:      From  the  U.S.  Public  Health  Service,  but  to  get  it  meant  that 
California  had  asked  for  it,  and  the  county  asked  for  it.   I 
thought  it  hadn't  been  too  productive  in  San  Diego.   If  the 
citizenry  are  not  too  poor,  and  reasonably  well-off  one  is  not 
going  to  find  much  TB  that  way.   TB  is  going  to  be  in  people  in 
your  jails,  and  in  your  slums.   There  were  some  bad,  poor 
neighborhoods  in  Contra  Costa,  especially  Richmond  and 
Pittsburg--some  really  ghetto  areas.   We  did  those,  and  a  lot 
more,  to  see  what  we'd  learn.  We  learned  a  lot  of  things  about 
our  citizenry,  their  awareness,  their  health,  their  medical 
care,  and  what  they  thought  of  county  health  services. 

But  I  also  thought  this  would  double  the  size  of  the  health 
department,  which  was  miserable,  and  it  did.   So  even  though 
the  money  was  put  up  as  temporary,  somehow  it  never  left  our 
budget.   Our  budget  just  skyrocketed  because  of  the  doubling  of 


136 


staff.   Of  course,  that  earned  me  the  ill  will  of  the 
taxpayers'  association,  and  that  was  kind  of  an  unpleasant 
aspect  of  our  department  coming  of  age. 

In  the  course  of  a  couple  of  years,  our  budget  kept 
doubling.   The  nursing  budget  brought  in  all  the  schools. 
There  were  "only"  thirty-four  school  districts  in  Contra  Costa 
County.   They  hadn't  amalgamated  yet,  and  the  county  was  full 
of  parents,  full  of  kids,  and  everything  seems  to  be  run  by  the 
PTA.   What  the  unions  and  industry  didn't  run,  the  PTA  did.   So 
we  dealt  with  the  school  districts,  and  their  PTAs,  and  they 
wanted  school  nurses.   I  thought  that  through  for  a  while  —  that 
would  double  our  nursing  staff  again,  maybe  triple  it. 

Crawford:   Schools  had  no  nurses  then? 

Blum:       Some  schools  had  a  lot  of  nurses.   They  wanted  us  to  take  over 
their  nurses,  and  the  ones  that  didn't  have  any  wanted  us  to 
provide  them.   I  thought,  "Now  this  is  kind  of  dumb.   We  will 
have  the  biggest  empire  in  this  county  in  short  order.   We  will 
be  a  target  forever  more  —  they  're  not  used  to  spending  this 
kind  of  money  on  the  health  department."   So  we  developed  a 
philosophy--Dr.  Yoshiye  Togasaki  and  I,  with  a  few  others. 

We  developed  the  philosophy  that  it  would  be  better  if 
other  organizations  had  the  huge  payrolls  and  the  huge  budgets, 
and  we  would  give  them  professional  or  expert  direction.   We 
struck  up  a  deal—and  the  county  board  wasn't  disapproving- -we 
would  hire  another  assistant  health  officer  to  be  in  charge  of 
the  school  work,  another  to  lead  the  children's  dental  program, 
and  the  schools  would  hire  the  nurses.   If  the  school  district 
couldn't  afford  nurses,  we'd  put  in  a  minimum  of  nursing  time, 
but  that's  all.   We'd  provide  the  medical  consultation,  the 
dental  program  (which  was  rather  elaborate),  and  we  would  do 
the  things  they  couldn't  do- -we  would  provide  the  technical 
leadership  for  their  health  program. 

That  turned  out  to  be  wise  because  if  our  budget  had  kept 
expanding  endlessly,  we  were  going  to  be  the  perfect  target  for 
all  kinds  of  interests.   Moreover,  we  would  probably  not  get 
the  cooperation  from  the  schools  if  they  were  faced  with  using 
services  directed  by  outsiders.   They  were  marvelous.   We  had 
no  end  of  cooperation,  but  we  gave  them  preventive  medical, 
dental,  other  kinds  of  services.   If  they  had  health  problems, 
we'd  get  there  right  now  to  take  care  of  them.   And  they  had 
problems  a-plenty,  so  we  made  lots  of  supporters  for  the  health 
department. 

Crawford:   How  was  your  budget  allocated? 


137 


Blum:      We  presented  it  first  to  the  administrator;  then  the 

administrator  worked  it  over  and  it  was  presented  to  the  board 
of  supervisors.  But  I  personally  presented  it  to  the  board  as 
health  officer. 

Crawford:   Generally  speaking,  what  needed  to  be  done? 

Blum:       Oh,  well,  everything.   We  didn't  even  have  a  laboratory.   When 
I  took  the  job,  the  state  health  department  said,  "This  is  the 
worst  health  department  in  the  state.   So  take  it  easy."   My 
logic  was,  "No.   If  we  take  it  easy,  that  is  what  we'll  have-- 
the  worst  health  department  in  the  state  forevermore . "   Then 
those  things  that  I  just  described  fortuitously  happened.   The 
Tuberculosis  Association  offered  all  their  big-wheel  support, 
and  then  the  PTAs .   These  are  the  folks  that  make  up  the  grand 
jury  and  all  the  community  organizations,  and  are  the  voters 
who  vote. 

Then  the  PTA  asked  me  to  make  a  few  talks  here  and  there, 
and  I  did.   The  next  thing  you  know  I  had  an  honorary  badge, 
and  pretty  soon  the  PTA  will  come  and  testify  about  what  they 
need,  and  what  their  kids  need.   Then  you  have  the  health  lobby 
all  built,  if  you're  willing  to  use  it.   Most  health  officers 
were  not,  apparently,  afraid  that  they  would  have  to  pay 
something  back.   But  PTAs,  Leagues  of  Women  Voters,  and  health 
associations  don't  want  things  for  themselves;  they  want  good 
health  for  everyone,  and  that  is  truly  easy  to  live  with. 

As  I  indicated,  we  didn't  need  everything  in  our  program. 
The  board  tried  to  give  us  the  dog  pound,  and  we  said,  "No  way. 
We're  not  taking  the  dog  pound."   I  offered  to  quit  if  they 
gave  us  the  dog  pound.   I  said,  "There  are  people  who  can  and 
have  run  the  dog  pound.   It's  either  public  works  or  the 
sheriff's  department  where  there  are  trucks,  communications. 
That's  not  a  health  department  job."   What  was  worth  our  time 
was  helping  the  school  nurses,  and  guiding  the  uses  of  the  huge 
amount  of  money  spent  on  various  school  budgets.   The  school 
nurse  is  tremendously  important.   In  those  days,  they  were  not 
just  the  doers,  they  were  the  teachers,  too.   They  taught  the 
teachers  about  health  matters,  organized  the  school  health 
programs.   You  could  get  health  services  and  observation  in  the 
schools  through  the  nurses  that  you  couldn't  get  in  any  other 
way.   Some  of  their  nurses  were  ex-nurses  from  our  service.   If 
the  schools  would  pay  more,  our  nurses  would  go  there.   They 
did,  and  it  didn't  hurt  us  as  they  got  employees  who  knew  what 
good  programs  were.   It  also  helped  raise  the  salaries  of  our 
nurses . 


138 


Signing  Off  on  Septic  Problems 


Blum:      There  were  many,  many  interesting  problems  of  many  different 

sizes.   One  day  early  in  my  career,  the  district  attorney  came 
in  (he  was  really  a  character—ultimately  became  a  state 
senator)  and  said,  "Here,  I  want  you  to  sign  these  papers."   I 
said,  "I  don't  know  what  they  are."  It  was  to  the  effect  that 
I  was  supposed  to  vouch  for  the  fact  that  this,  that,  and  the 
other  thing  is  getting  done  in  a  subdivision.   "I  don't  even 
know  where  the  subdivision  is."  He  said,  "Well,  that's  all 
right.   Your  predecessor  never  worried  about  that.   He  just 
signed.   Now,  here,  sign  them."  Well,  I'm  not  signing  a  thing 
if  I  don't  know  what  I'm  signing. 

The  district  attorney  is  a  powerful  man,  and  so  I  suggested 
that  maybe  he  spend  a  little  time  with  us,  telling  us  what  it 
was  all  about.   If  we  signed,  we  were  testifying  that  the 
subdivision  could  get  rid  of  sewage,  had  safe  water,  and  a  few 
other  things.   I  said,  "How  do  I  know  what  the  sewage  disposal 
is  like?"   "Well,  it's  got  all  septic  tanks,  and  the  building 
department's  inspected  it.   The  building  department  signed  off, 
but  their  signature  doesn't  count.   It  has  to  be  the  health 
officer's."  On  quizzing  our  own  sanitary  inspectors,  it  was 
their  impression  that  the  septic  tanks  wouldn't  last  more  than 
a  month  or  two  or  three,  and  then  the  sewage  would  be  out  in 
the  neighborhood.   I  told  him,  "If  you  think  I'm  going  to  sign 
this,  you're  crazy." 

About  ten  minutes  later,  the  chairman  of  the  board  of 
supervisors,  who  was  a  nice  guy--an  electrical  contractor  named 
Jack  Cummings-- comes  in.   He's  a  great,  big,  handsome  fellow. 
He  said,  "Doc,  I  hear  you  won't  pass  this  subdivision.   You've 
got  to  sign  these.   My  god,"  he  said,  "A  couple  of  us  have  a 
quarter  million  dollars  in  it."  He  said,  "That's  the  kind  of 
money  they  owe  us  for  the  work  we  did  there."  He  had  nothing 
to  do  with  the  septic  tanks  and  he  was  the  chairman  of  the 
board  of  supervisors. 

I  said,  "Well,  Mr.  Cummings,"  I  got  to  know  him  as  Jack, 
ultimately,  "if  I  sign,  there's  going  to  be  nothing  but 
trouble."  I  said,  "We've  been  thinking  about  it.   If  we  open 
up  a  couple  of  septic  tanks—we'll  let  them  open  them  up— and 
if  they  look  like  they'll  work,  we'll  let  the  subdivision  go. 
But  I'm  never  signing  another  one  because  I  don't  think  any  of 
these  will  work  from  what  I've  heard,  even  though  it's  been 
inspected  and  cleared  by  the  building  department." 


139 


He  said,  "Well,  what  would  you  have  to  have?"   I  said,  "We 
have  to  have  a  new  ordinance,  we've  got  to  have  the  manpower  to 
inspect,  and  contractors  have  got  to  meet  certain  standards." 
They're  well-known,  basic  standards.   Everybody  else  is  using 
them.   In  a  way,  this  was  blackmail.   Another  member  of  the 
board  was  the  real  estate  agent  for  the  subdivision.   He  was 
another  nice  guy.   These  were  kind  of  fun  people,  but  this  had 
been  going  on  forever,  and  the  health  officer  had  been  the 
stooge  who  allowed  it  to  happen. 

So  I  passed  the  word:  "I  want  to  see  three  septic  tanks"-- 
there  were  probably  thirty--"in  different  places  in  that 
subdivision.   Open  up  any  ones  you  want.   If  you  think  there's 
a  good  one  out  there,  we'd  be  glad  to  see  it." 

So  they  opened  up  three  septic  tanks.   They  were  all 
disasters,  all  of  them.   They  were  made  out  of  redwood  bark, 
not  wood—they  used  to  get  big  slabs  of  bark  from  big  redwood 
trees.   They  were  about  six  feet  long  and  two  inches  thick,  six 
or  eight  inches  wide.   The  builder  put  one  nail  in  at  each  end, 
put  a  little  tar  paper  over  it--not  even  wood,  you  know,  just 
bark.   They  had  scooped  out  a  hole  with  a  clam  shell.   Then 
they  put  this  box  down,  brought  up  some  terra  cotta  piping  to 
it  from  the  house,  and  some  more  from  the  tank  to  make  up  the 
drain  field,  and  used  a  caterpillar  to  push  the  dirt  back  in 
around  it,  and  it  was  done.   Our  inspectors,  who  had  not  had 
anything  to  do  with  the  inspection  but  who  couldn't  resist 
watching  because  they  knew  they  would  be  called  in  as  soon  as 
the  septic  tanks  failed,  said  the  tanks  would  almost  for  sure 
be  collapsed  because  the  cat  had  gone  over  them  while  pushing 
the  dirt  around,  and  the  pipes  were  being  broken  and 
disconnected.   This  "tank"  would  hold  sewage  for  a  week,  a 
month,  two  or  three  months,  and  then  it's  over.   There's  no 
septic  tank  there. 

I  had  told  the  contractor  that  I  didn't  want  them  to  fix 
anything,  that  I  wanted  to  come  out  and  see  the  tanks  as  they 
were  exposed.   I  get  out  there,  and  here's  one  that  has  all  new 
pipes  and  fresh  cement.   It  was  still  a  disaster,  and  this  guy 
said,  "Oh,  it's  them  goddamned  niggers  that  work  for  us.   They 
just  do  these  things."  Really  "nice"  people.   So  we  suggested 
that  they  dig  up  a  few  more  and  fix  them  all,  and  shape  them 
up.   We  approved  the  subdivision  on  the  understanding  that  the 
board  was  providing  a  new  ordinance,  that  we  doubled  our 
sanitation  crew  and  started  life  anew  with  a  suitable  permit 
and  inspection  program.   Over  my  desk,  for  all  the  years  I  was 
there,  was  this  great  big  piece  of  bark  that  came  from  one  of 
those  septic  tanks.   I  also  learned,  though,  that  when  we  had 
trouble  in  these  situations,  I  could  not  take  colored  pictures 


140 


with  my  camera,  because  even  sewage  looks  good  in  a  colored 
picture.   So  we  turned  to  taking  black  and  white  pictures  for 
evidence.   [laughs] 


The  County  Hospital  and  George  Degnan 


Blum:      The  county  hospital  was  totally  separate  from  the  health 

department.   That  was  run  by  a  master  politician  and  super 

surgeon,  George  Degnan.   A  tremendous  fellow.   He  was  the  chief 

surgeon,  and  chief  doctor,  and  chief  everything.  He  was 
actually  a  fabulous  surgeon. 

Crawford:   Talk  about  him--I  believe  he  was  medical  director  from  about 
1948  to  1980? 


Blum:      Oh,  he  was  a  handsome,  great,  big  guy--a  woman's  dream  of  a 

chunk  of  man.   Women  were  always  tagging  after  him.   He  was  a 
star  football  player  here  at  Cal  in  his  earlier  years. 

Crawford:   He  was  a  local  person,  wasn't  he? 

Blum:      He  grew  up  in  Richmond,  I  think.   He  was  a  fine  athlete,  and  a 
marvelous  doctor.   I  was  impressed,  because  at  the  county 
hospital,  I  undertook  to  make  the  rounds  on  the  contagious 
disease  ward.   They  didn't  have  any  expert  on  that  and  they  had 
done  some  stupid  things  as  a  result.   So  I  did  that  because  I'd 
done  a  lot  of  it  in  San  Diego,  and  I  saw  a  lot  of  George  and 
his  work  as  a  result. 

Crawford:   Was  that  part  of  your  role? 

Blum:      No,  but  everybody  would  be  happy  if  I  did  become  the  visiting 
M.D.  on  the  infectious  disease  ward.   I  had  a  good  time  there, 
and  saw  all  kinds  of  interesting  cases.   We  got  contagious 
disease  cases  from  Solano  County,  and  we  saw  a  fair  variety  of 
contagious  diseases.   The  ward  served  the  contagious  disease 
needs  of  the  300,000  persons  in  the  county  at  that  time. 

Crawford:   Was  that  where  services  to  the  poor  were  delivered? 

Blum:      Yes,  but  everybody  with  contagious  diseases  also,  because  other 
hospitals  didn't  want  to  fool  around  with  them.   They  were  too 
expensive,  too  tricky,  and  if  the  disease  spread  in  the 
hospital,  it  would  be  a  true  disaster  for  them. 


141 


George  was  a  magnificent  character.   He  was  a  strong  labor 
man.   He  had  ties  to  the  unions  that  even  an  episode  of 
scabbing  couldn't  kill.   George  actually  could  tell  the  board 
of  supervisors  what  was  going  to  happen  because  the  unions  had 
the  votes.   One  supervising  district  was  controlled  by  farmers, 
but  unions  ran  the  rest  of  them.   Even  though  the  big  oil 
companies  and  the  chemical  companies  had  a  lot  to  say,  the 
truth  of  the  matter  was  that  their  unions  often  had  more  to 
say,  since  it  was  their  members  who  voted,  and  they  often 
agreed.   So  it  wasn't  all  that  hard  to  get  what  they  wanted. 
George  had  the  union  vote.   I  had  the  PTA  vote,  which  was 
growing  more  powerful  each  year  as  the  county  became  a  major 
bedroom  suburb  of  the  Bay  Area. 

Crawford:   Were  you  opposed  to  each  other? 

Blum:      Yes,  you  see,  he  would  influence  the  budget  one  way,  and  I 

would  tend  to  influence  it  another  way.   We  would  draw  from  the 
same  basic  pool  of  funds  for  competing  purposes. 

Crawford:   Oh,  his  budget  was  a  generalized  medical  budget? 

Blum:      His  was  a  big  county  hospital  budget,  while  ours  had  little  for 
medical  care  as  such.   They  also  did  the  tuberculosis  patient 
care,  and  did  a  terrible  job  as  far  as  we  were  concerned.   We 
finally  forced  the  issue  and  then  he  put  his  chief  assistant  on 
the  job--a  physician  by  the  name  of  Louis  Girtman--and  Louie 
was  another  marvelous  person.   He  came  out  of  the  Ozarks,  and 
he  didn't  care  to  work  with  rich  people.   He  loved  poor  people. 
He  could  empathize  with  them.   He  worked  all  his  life  with  poor 
people—he  worked  day  and  night  at  that  county  hospital.   Louie 
took  over  the  TB  program  and  paid  attention  to  what  we  believed 
had  to  be  done,  and  they  started  doing  a  good  job. 

We  were  always  crossing  paths.   We  had  the  contagious 
disease  people  in  common,  and  we  were  responsible  for  them,  but 
they  took  care  of  them.   We  were  responsible  for  TB,  but  they 
took  care  of  the  TB  patients.   They  were  responsible  for  rehab, 
but  we  ran  the  crippled  children's  program.   We  even  built  a 
rehab  unit  there  at  the  county  hospital.   We  found  money  for 
this  and  money  for  that,  and  if  we  could  create  anything  for 
the  county  hospital,  it  was  great  by  them.   We  created  a 
building  in  Richmond,  I  got  the  money  for  it  because  of  the  way 
funding  was  arranged  for;  the  county  hospital  used  most  of  it. 
I  was  on  the  governor's  hospital  council  which  made  all  the 
decisions  on  the  awards  of  Hill-Burton  Act  funding.   We  created 
a  building  in  Pittsburg,  and  the  county  hospital  used  most  of 
it.   It  was  an  odd  sort  of  competition.   We  wanted  the  same 
things  done,  but  they  were  usually  at  a  different  part  of  the 


142 


ball  game  than  we  were.   So  we  were  always  competing,  and 
George  had  more  influence,  so  we  had  to  work  harder. 

Crawford:   Where  did  he  get  the  influence? 

Blum:      Labor.   You  see,  even  the  merit  board  in  civil  service  that 

would  set  salaries  was  run  by  labor,  and  George  had  the  civil 
service  board  at  his  beck  and  call,  but  not  the  civil  service 
department  employees.   We  both  hated  the  civil  service 
department  employees.   They  always  kept  telling  us  what  we 
wanted,  and  they  didn't  know  anything  about  health.   So  we 
could  sort  of  commiserate. 

But  when  we'd  get  there  for  negotiations,  we'd  sort  of  be 
pulling  apart  for  other  reasons.   For  instance,  he  wanted  to 
pay  his  nurses  more  than  we  wanted  to  pay  ours.   Well,  ours 
were  all  better  trained.   Ours  all  had  an  extra  degree.   But 
we  kept  up  a  fairly  friendly  exchange.   He  was  at  our  house  for 
dinner,  and  he'd  take  us  out.   He  was,  at  that  time,  a 
bachelor;  although  he  shortly  had  a  wife  and  children.   He  may 
have  had  another  child  from  a  first  marriage  to  a  very 
prominent  San  Francisco  socialite. 

Crawford:   I  know  June  Degnan. 

Blum:      June.   That  was  his  first  wife.   I  don't  know  for  sure  if  they 
had  children  or  not,  but  I  knew  the  second  wife.   They  had  a 
couple  of  kids  who  are  now  doctors.   I  never  did  meet  June,  but 
we  saw  George  a  lot  of  times.   We'd  go  here  and  there  to  dinner 
together.   We  really  wanted  the  same  things  for  the  same  kind 
of  people.   We  had  the  same  general  approach  to  life.   But  he 
was  a  surgeon,  and  I  was  a  public  health  officer--!  mean,  we 
were  getting  to  heaven  through  different  worlds. 

Crawford:   What  was  the  practical  basis  of  the  difference? 

Blum:      The  difference  wasn't  so  much  about  what  we  wanted,  but  he 

wasn't  fussy  about  how  he  got  things.   I  was  very,  very  queasy 
about  getting  things  in  what  I  saw  as  underhanded  ways. 

Crawford:   By  means  of  labor  tactics? 

Blum:      Yes,  just  across  the  board.   I  remember  one  night  we  were  at 
our  house,  and  he  was  saying,  "With  the  politicking  you're 
doing...."   I'd  just  won  something  away  from  him,  you  see. 
"You  know,  this  is  terrible,"  he  said,  "You  go  around  kissing 
babies  and  all  this  PTA  stuff."   [laughs]   Well,  you  just  had 
to  laugh,  you  know,  because  that's  how  he  saw  it.   Here  I  was 
"playing  the  women's  side  of  the  street,"  and  he  was  playing 


1A3 


the  men's  side  of  the  street,  all  those  tough  labor  guys.   Yet 
we  pretty  well  pulled  together  over  the  years.   We  got  some 
really  good  programs  going  between  us. 

Crawford:   That's  where  the  first  county-run  HMO  came  out  of,  wasn't  it? 
Blum:      It  came  out  of  his  bailiwick. 
Crawford:   Were  you  involved  with  that? 

Blum:      Not  really.   I'd  give  it  moral  support,  but  it  was  not  ours  to 
organize.   He  had  dreams  that  we'd  have  universal  coverage  one 
of  these  days,  and  he  wanted  to  work  his  people  into  a  system 
where  it  would  work  that  way.   When  he  was  allowed  to  replace 
the  hospital  there,  he  built  a  temporary  hospital—one  that  was 
only  going  to  last  twenty  or  thirty  years—because  county 
hospitals  would  be  past  history,  and  there  would  be  no  more 
county  hospitals  when  there  would  be  universal  coverage.   He 
was  very  alert,  and  his  heart  was  in  the  right  place,  but  his 
timing,  as  well  as  mine  and  everyone  else's,  was  off  by  a  half- 
century  or  more.   There's  still  no  universal  coverage  in  sight. 

Crawford:   He  thought  everything  would  be  universal  coverage.   What  was 

coverage  like  back  then?   I  guess  we're  talking  about  the  early 
fifties. 

Blum:       You  got  insurance  with  some  jobs,  but  a  lot  of  people  didn't 

have  that  kind  of  a  job.   Almost  nobody  could  ever  afford  their 

own  private  insurance.   Nobody  had  it.  Not  for  health  care. 
It  was  a  dilemma. 

Crawford:   Was  that  at  all  unethical  to  build  a  hospital  for  twenty  years, 
with  built-in  obsolescence? 

Blum:      Oh,  no.   It  was  wise.   Everybody  else  was  building  monuments, 
and  here's  George  saying,  "Okay,  we  don't  need  a  monument.   It 
will  be  gone.   We  won't  need  it."  This  is  the  head  of  the 
county  hospital  saying  we  don't  want  a  county  hospital. 

Crawford:   Did  the  two  of  you  reinforce  each  other  in  the  community? 

Blum:      In  a  sense,  yes.   Yes.   I  mean,  we  were  constantly  friendly 

enemies  or  friendly  competitors,  or  something.   I  remember  when 
the  Easter  Seal  Society  came  around  and  wanted  us  to  do 
something.   They  were  going  to  put  on  a  big  campaign,  and  the 
campaign  was  to  state  that  our  county  health  department  had  the 
best  crippled  children's  service  in  the  state.   Well,  it 
probably  did,  but  that's  nothing  to  put  into  a  campaign  which 
is  going  to  tell  my  board  that  their  health  department  is  the 


Crawford; 
Blum: 

Crawford: 
Blum: 


best  in  the  world  therefore  it  won't  deserve  any  significant 
new  funding.   I  mean,  one  just  can't  say  stupid  things  like 
that. 

George  was  at  the  meeting.   It  was  in  my  office,  I 
remember,  he  was  this  big  handsome  guy,  and  he  was  listening  to 
these  ladies  who  were  driving  me  nuts.   They  just  could  not  be 
talked  out  of  it.   I  said,  "Look  here,  it's  our  county,  and 
you're  coming  from  San  Francisco  and  are  telling  me  how  to  play 
ball  here.   We'll  get  you  whatever  you  want,  because  we  want 
the  same  things,  but  don't  come  out  with  this  kind  of 
propaganda,  like  it's  the  best  program  in  the  world.   It's 
insane."  They  just  couldn't  hear  me.   So  I  got  up  and  walked 
out,  slammed  my  own  door,  and  left.   George,  they  tell  me 
afterwards,  turned  to  look  at  these  people  —  and  he  hadn't  said 
a  thing  all  this  time  —  and  he  said,  "Well,  I  think  that  settles 
that,  doesn't  it,  ladies?"   He  was  a  good  ball  player,  a  good 
card  player,  a  good  poker  player,  and  it  worked.   They  came 
around  and  did  what  we  wanted.   It  all  worked  out  very  well  our 
way  without  our  telling  the  world  we  had  the  best  health 
department.   If  you  do  something  like  that,  you're  crazy. 

We  worked  together  all  the  time.   We  got  in  the  mental 
health  program.   We  got  a  huge  program. 

You  got  a  huge  one  for  his  hospital? 

Well,  for  the  county.  It  included  the  hospital's  needs.  But 
the  only  way  we  were  going  to  get  it  decently  done  was  to  let 
him  run  it.  So  we  did. 

Was  it  a  good  mental  health  program? 

It  was  super,  the  only  one  of  its  kind.   In  its  day,  it  was  a 
very  fascinating  thing.   We  hired  psychiatrists  to  come  in  and 
work  with  human  service  departments  once  a  week— so  much  time 
spent  with  department  heads,  then  some  more  time  with  people  in 
charge  of  the  mental  health  aspects  of  their  programs.   The 
partners  included  the  school  districts,  junior  college, 
hospital,  health  department,  police  departments,  sheriff's 
department,  probation,  and  welfare.   We  even  taught  cops  how  to 
bring  deranged  and  violent  persons  into  custody  without  having 
to  knock  their  brains  out.   "You  don't  have  to  subdue  violent 
people  with  violence.   There  are  many  ways  of  doing  this,  even 
if  persons  are  violent  when  you  come  to  get  them."  We  did  all 
sorts  of  things—advised  judges.   It  was  a  tremendous  mental 
health  program.   It  was  a  kind  of  "trickle-down"  business. 


145 


Crawford: 
Blum: 


Crawford: 
Blum: 


There  were  no  psychiatrists  in  Contra  Costa  County  when  I 
came  there,  and  by  means  of  this  program  we  got  outstanding 
psychiatrists  to  give  the  key  departments  a  way  to  proceed. 
The  next  thing  you  know,  every  department  had  a  mental  health 
trained  person  as  each  hired  folks  that  had  Ph.D.'s  or  M.D.'s 
or  some  degree  in  mental  health,  and  they  advised  the  various 
human  service  workers,  teachers,  police  how  to  better  deal  with 
mental  illness  or  emotional  problems  in  their  own  department. 
George  finally  got  some  psychiatrists  at  the  county  hospital. 
All  of  a  sudden,  we  had  a  program  that  really  trickled  down  all 
the  way  to  the  thousands  of  people  who  needed  help. 

The  next  thing  you  know,  Contra  Costa  was  a  bonanza  for 
psychiatrists.   I  never  was  sure  we  did  the  right  thing, 
because  everybody  who  could  not  be  cared  for  by  our 
intermediate-level  workers  was  being  referred  to  psychiatrists. 
But  the  county's  program  was  relatively  low-cost.   Of  course, 
we  still  had  to  hospitalize  the  serious  mental  health  cases  in 
the  county  hospital.   That  was  George's  real  leg  to  stand  on, 
and  they  indeed  had  a  very  interesting  service  there.   They  did 
all  kinds  of  good  things.   Well,  the  overall  program  went  to 
George  for  administration,  and  nobody  fought  it.   We  had  all 
fought  together  to  get  him  the  money  so  he  could  do  it.   The 
same  psychiatrist  who  headed  it  up  in  the  fifties  is  still 
there . 

The  county  hospital  was  in  Martinez? 

In  Martinez.   It's  still  there.   Now  it's  being  rebuilt.   The 
old  monster  had  to  be  torn  down.   The  new  one's  going  up.   It's 
a  highrise,  and  there's  a  great  question  whether  it's  needed 
now.   That  wasn't  his  fault. 

The  community  wanted  that? 

Well,  it  was  a  huge  battle  because  organized  medicine  and  the 
other  hospitals  didn't  want  it  to  be  rebuilt.   The  county 
pointed  out  that  it  had  to  take  care  of  the  people  the  other 
hospitals  didn't  want.   "Oh,  we'll  take  them,  we'll  take  them," 
was  their  response.   But  before  it  was  all  through,  they  didn't 
want  the  criminals,  they  didn't  want  contagious  disease,  and 
they  didn't  want  this,  and  they  didn't  want  that. 

So  all  the  tough  cases  were  going  to  be  left  for  the  county 
hospital.   That  means  the  county  hospital  had  to  have  a 
pharmacy  and  surgery  and  x-ray  and  all  those  social  services. 
So  the  county  still  had  to  create  all  the  expensive  parts  of 
the  hospital,  for  just  a  few  special  and  very  expensive  kinds 
of  clients. 


146 


Crawford:   Did  he  want  them  to  be  treated  in  their  own  communities? 

Blum:      Oh,  George  was  gone  already.   George  had  retired,  but  he 

continued  to  fight  against  the  new  hospital.   He  thought  it 
ought  to  be  disposed  of,  once  and  for  all.   That's  what  he  died 
over,  supposedly.   He  was  in  his  eighties,  still  fighting. 
Didn't  think  a  new  hospital  should  be  built  just  for  the  poor 
and  a  few  special  categories  of  patients,  that  the  poor  could 
just  as  well  be  served  where  everybody  else  went.   But  the 
private  facilities  wouldn't  play  ball  as  late  as  1995,  and  the 
board  of  supervisors  had  no  choice  since  they  have  the  legal 
responsibility  to  cover  those  with  no  other  source  of  care- 
best  known  as  the  county  "safety  net". 

Crawford:   So  that  must  have  been  a  major  frustration  for  Degnan? 

Blum:  Yes,  his  big  dream--and  mine  too—that  we  wouldn't  need  things 
like  county  hospitals.  Who  the  hell  needs  them,  really?  Just 
another  set  of  facilities  for  everyone  to  pay  for. 

Crawford:   It's  discrimination. 

Blum:      Of  course  it  is,  and  a  terrible  waste  of  money,  full  in  hard 
times,  empty  in  good  times,  just  the  reverse  of  the  other 
hospitals . 

Crawford:   What  other  major  problems  did  you  confront  initially? 


Sanitation  Problems  and  County  Restaurants 


Blum:      Well,  on  the  other  side  —  the  sanitation  side  —  there  were  other 
messes  like  those  with  the  septic  tanks.   Food  sanitation  was  a 
terrible  thing. 

Crawford:   You  touched  on  that;  said  you  closed  down  scores  of  places. 
You  weren't  very  popular. 

Blum:      Oh,  hundreds,  literally  hundreds.   I  remember  going  as  one  of 
the  honored  guests  to  the  annual  banquet  of  the  food 
distributors  in  Jack  London  Square.   All  the  health  officers  in 
the  East  Bay  were  invited,  and  there  were  quite  a  few  of  them 
at  that  time.   I  remember  that  they  had  this  lady  from  Broadway 
and  Columbus—Carol  Doda.   With  the  tremendous  superstructure. 
She  was  the  entertainment  and  she  was  going  to  introduce  us. 
[ laughter] 


147 


Oh,  well,  this  is  not  a  highly  cultured  crowd—the  food 
distributors,  liquor  distributors,  and  tobacco  distributors. 
But  these  are  all  the  real  folks  that  count.   When  they 
introduced  us,  and  my  name  came  up,  you  never  heard  such  a 
booing  in  all  your  life.   [laughter]   I  thought,  "Boy,  I'm  not 
even  safe  here." 

Crawford:   Well,  what  did  you  expect? 

Blum:      Well,  I  thought  they'd  be  civil.   [laughter]   So,  then,  we  had 
Carol  Doda,  and  they  didn't  treat  her  like  that.   She  danced  on 
the  table  tops.   So  that  was  my  standing.   It  was  pretty  good, 
in  one  sense.   At  least  they  knew  we  were  there.   We  had  closed 
hundreds  of  unsafe  places. 

Crawford:  What  did  you  find? 
Blum:  Filthy  operations. 
Crawford:  No  health  standards  whatsoever? 

Blum:      No,  yet  we  had  inspectors  —  college  trained,  most  of  them— but 

business  is  business,  and  if  the  boss  doesn't  insist  on  it,  the 
inspectors  go  along  with  the  operators.   For  instance,  San 
Francisco  was  a  scandal.   Its  food  places  always  were. 

Crawford:   And  it  is  still? 

Blum:      Of  course.   I'll  never  forget,  I  took  somebody  out  to  dinner  at 
a  fancy  place  down  on  Maiden  Lane  with  a  French  name.   It  used 
to  be  out  on  Geary  Street. 

Crawford:   Is  that  the  Fleur  de  Lys? 

Blum:      No,  no.   Not  that  one.   This  is  another  one.   Any  event,  it  was 
very  ritzy  and  expensive,  and  here  comes  the  butter  dish,  and 
out  from  behind  the  butter  cubes  comes  the  biggest  cockroaches 
you've  ever  seen.   [laughter]   Things  to  admire,  like  in  the 
tropics.   And  these  were  just  little  old  cockroaches  grown  to 
giant  size! 

Well,  San  Francisco  always  had  filthy  food  handling  places. 
I  remember  I  used  to  eat  in  the  New  Pisa.   One  night  my  wife 
was  in  the  city.   I  was  coming  from  the  airport,  and  we  invited 
one  of  my  assistant  health  officers  to  dinner  there  in  the  New 
Pisa.   He'd  never  been  there.   We  met  there,  and  they  had  very 
good  food.   I  mean,  they  really  had  good  food.   They  knew  how 
to  make  raviolis.   You  can't  get  them  like  that  anymore.   Well, 
he  was  in  the  men's  room  to  wash  his  hands,  and  he  comes  back 


148 


and  he  says,  "Say,  Boss,  would  a  place  like  this  be  allowed  to 
be  open  in  Contra  Costa  County?"   I  said,  "No,  not  by  any 
stretch  of  the  imagination."   [laughter]   That  was  not  the 
worst  in  San  Francisco,  but  their  men's  room  was  something  else 
again,  and  their  ladies'  room  wasn't  any  better.   The  new  New 
Pisa  is  okay. 

Contra  Costa  had  been  like  that.   I  had  a  dear  auntie  who 
came  out  to  spend  a  few  weeks  with  us  in  the  fifties,  and  1 
asked  the  inspectors,  "Where's  a  good  place  to  take  my  aunt?" 
I  knew  the  San  Francisco  restaurants,  but  then  you  have  to  go 
back  and  forth  to  the  city.   They  said,  "Well,  to  tell  you  the 
truth,  there's  only  two  clean  ones.   There's  a  third  one, 
sometimes."  This  is  in  all  of  Contra  Costa  County.   I  said, 
"You've  got  to  be  kidding."   They  said,  "No,  no.   Cape  Cod 
House—that '  s  good.   That's  how  a  restaurant  ought  to  be  run." 
Then  there's  this  little  place  I'd  never  heard  of--this  Italian 
place  —  in  Pittsburg.   They  said  that  was  a  really  nice  and 
clean  place.   So  I  decided  to  start  visiting  restaurants  myself 
at  night,  after  work.   I'd  start  out  sometime  around  four  or 
so,  and  inspect  half  a  dozen,  even  a  dozen  places  in  an 
evening. 

it 

Blum:       Once  at  a  San  Pablo  restaurant  early  in  my  career  as  a  health 

officer,  another  aspect  of  law  enforcement  came  to  my  attention 
rather  abruptly.   A  Chinese  inspector,  one  of  two  Asians  in  a 
team  of  fifteen,  called  to  say  that  an  irate  cafe  operator  had 
driven  him  out,  saying  that  "no  Chink  was  going  to  tell  him 
what  to  do."   What  should  we  do  next,  the  inspector  wanted  to 
know. 

This  seemed  like  a  good  educational  opportunity,  so  I  asked 
him  to  get  me  the  phone  number  of  the  cafe.   I  made  a  call  to 
the  operator,  telling  him  who  I  was,  and  that  we  had  no 
intention  of  making  him  accept  any  one  inspector,  and  that  I 
would  be  happy  to  inspect  his  place  myself  the  very  next 
morning. 

This  would  give  him  time  to  clean  up,  but  the  place  was  so 
bad  that  it  probably  wouldn't  look  a  lot  different  the  next 
day.   I  came  in  quite  cordially,  repeated  my  friendly  offer  of 
doing  the  inspection  myself,  took  out  the  rating  sheet  that  we 
always  used,  and  went  to  work.   I  interpreted  the  ratings  quite 
literally,  and  the  operator  got  sicker  and  sicker,  assured  me 
that  he  loved  Joe,  couldn't  Joe  come  back  and  they  would  get 
the  corrections  done  in  jig  time. 


149 


Joe  told  me  that  he  never  had  a  more  cooperative  operator, 
and  that  they  got  along  fine  after  that. 

I  guess  the  method  was  not  to  back  down  if  we  were  right, 
but  to  try  another  tack  and  not  attack  frontally,  such  as 
shutting  the  place  down,  which  we  had  the  authority  to  do. 

The  matter  of  law  enforcement  remained  a  fascinating  area-- 
a  kind  of  battleground  between  ethics  and  the  presumably 
justified  exercise  of  power.   One  incident  that  I  find  hard  to 
forget  is  St.  Mary's  College  in  Moraga.   Their  students  and  the 
faculty  ate  their  meals  there.   As  part  of  our  routine 
inspections,  we  gave  them  a  Catholic  inspector  who  had  a  hard 
time  educating  them  up  to  standards.   The  food  service  was 
leased  out  to  a  major  so-called  first-class  operator,  but  the 
plant  itself  was  decaying  and  impossible  to  maintain.   It 
finally  got  too  bad  and  we  gave  them  a  notice  of  forthcoming 
closure  if  repairs  weren't  underway  in  two  weeks. 

The  senior  Brother  Albert  in  charge  (there  were  two 
Brothers  Albert,  and  the  senior  one  seemed  to  fancy  himself  as 
a  direct  emissary  of  God)  called  me  to  tell  me  that  he  was 
going  to  have  ray  job,  four  county  supervisors  being  Catholic, 
the  fifth  in  a  Catholic  district,  and  the  county  manager  was 
also  a  Catholic. 

I  didn't  object  to  his  approach  but  explained  that  there 
would  be  an  official  closure  (if  there  wasn't  compliance)  and 
that  anyone  violating  the  closure  would  be  served  with  a 
warrant  for  arrest.   At  this  point  some  200-plus  students  came 
down  with  food  poisoning  and  we  closed  the  food  facility  on  the 
spot,  a  week  or  so  ahead  of  the  threatened  date. 

I  never  did  know  if  Brother  Albert  also  got  the  crud  as 
extra  punishment.   I  suspect  not,  because  he  went  skiing  at 
this  point,  and  on  the  way  home  drove  into  a  tree  and  killed 
himself.   I  always  hoped  that  we  were  not  a  contributing 
factor,  rather  that  the  Good  Lord's  way  simply  took  place, 
solving  all  Brother  Albert's  problems  and  one  of  mine. 

II 

Blum:      There  were  many  kinds  of  things  in  the  sanitation  field.   I 
mentioned  that  I  had  a  wonderful  sanitarian  who  was  born  and 
raised  in  the  Ozarks,  who'd  gotten  his  training  during  the  war 
in  the  navy.   Bill  Martin.   I  don't  know  if  he's  alive  now,  or 
not.   He  became  the  head  of  the  sanitation  program  in  another 
county  when  he  retired  from  Contra  Costa.   He  could  see  the 
unfairness  of  a  lot  of  these  things.   It  bothered  him.   He  was 


150 


just  an  unsophisticated  person  who  hadn't  been  educated  to 
overlook  the  real  problems.   He  had  enough  education  to  carry 
out  the  law  and  do  it  well,  and  as  I  told  you,  we  were  fairly 
tough  about  enforcing  the  food  laws. 

Crawford:   That's  what  you  said.   You  got  booed  at  the  annual  banquet. 

Blum:      Yes,  well.   I  don't  know  if  I  told  you  about  this  or  not,  but 

Bill  led  me  out  to  a  little  place  that  he  was  going  to  clean  up 
in  north  Richmond- -a  black  community --where  one  way  or  another 
you'd  say,  just  as  you  did  in  any  other  community,  "Do  this,  do 
that,  and  if  you  don't  do  it  in  so  many  days  or  weeks,  we'll 
close  your  store."  That's  it—very  simple,  very  fast,  very 
direct,  very  legal.   Well,  he  said,  "Boss,  I  want  you  to  see 
this  —  see  how  you  feel  about  it."  Having  presided  at  the 
closure  of  a  Safeway  and  a  lot  of  other  stores,  he  had  a  good 
idea  of  what  we  did  for  businesses  that  wouldn't  stay  clean. 

Here  was  a  little  old  shack;  it  was  kind  of  cute.   It  had 
all  new  roofing  on  the  outside- -the  fireproof  kind.   You 
couldn't  really  complain,  you  just  weren't  used  to  seeing 
roofing  on  the  wall.   I  got  inside,  and  here  was  a  brand  new 
floor—a  maple  floor— and  it  had  funny  little  white  bands  here 
and  there.   I  asked  what  kind  of  floor  it  was,  and  he  said, 
"It's  an  old  basketball  court  I  found."  Those  were  the  little 
white  marks.   [laughter]   Well,  they  put  it  all  in  just  so,  and 
then  the  shelves  were  all  painted  white.   There  was  a  little 
stack  of  groceries  on  this  shelf,  and  a  little  stack  on  that 
one. 

The  owners  couldn't  afford  anything.   It  was  a  little 
neighborhood  store,  and  it  probably  fed  them  at  wholesale 
prices,  but  they  were  there,  serving  their  immediate  community. 
Then  he  had  a  stainless  steel  sink,  and  I  said,  "Bill,  how  did 
you  ever  get  that?"   He  said,  [drops  his  voice,  so  is  almost 
inaudible]  "I  saw  it  out  in  a  wrecking  yard  and  they  got  it  for 
a  couple  of  bucks."  He  said,  "How  do  you  feel  about  all  of 
these  changes?"   I  said,  "Wonderful.   It's  fabulous."  He  said, 
"Well,  that's  what  I  was  thinking.   They  couldn't  do  this  by 
themselves,  but  with  a  little  help,  they  could.   Otherwise, 
we'd  close  them  and  send  customers  to  Safeway  up  the  street." 

That  was  Bill's  way  of  doing  the  job  without  following  the 
steps  laid  out  in  the  food  ordinance.   He  got  them  to  achieve 
the  sanitary  results  called  for  in  the  law.   In  other  words,  he 
was  coming  out  with  the  results  that  the  law  intended. 

Crawford:   He  didn't  like  to  see  them  closed  up? 


151 


Blum:      He  didn't  like  to  see  people  hurt.   His  education  hadn't 

overcome  his  good  sense.   He  did  many  such  things.   He  cleaned 
up  the  city  of  San  Pablo.   We  knew  it  was  a  death  trap  in  many 
places.   There  were  rubbish  piles,  rodents,  big  piles  of 
lumber.   Many  of  the  people  who  came  in  for  the  war  effort 
could  barely  afford  a  packing  box  for  a  house. 

Crawford:   San  Pablo  was  worse  than  Richmond? 

Blum:      Oh,  yes.   Richmond  had  pretty  good  standards.   Richmond  had 
poor  people,  but  everything  was  done  according  to  the  book. 
There  was  a  health  officer  there—an  independent  one  —  and 
ultimately  we  absorbed  that  department.   He  was  good.   He  got 
good  support.   It  was  a  strong  labor  town,  so  there  wasn't  too 
much  trouble  targeting  for  reasonably  safe  housing  and  streets, 
public  services. 

San  Pablo  was  a  whole  other  story;  that  was  the  home  of 
gambling  and  prostitution;  it  was  a  rough  little  neighborhood. 
The  mayor  of  San  Pablo  owned  a  restaurant,  and  it  was  filthy, 
vile.   I  remember  going  down  there  because  we  were  going  to 
close  him.   He  wouldn't  correct  it.   There  were  mouse  droppings 
all  over  everything.   He  was  a  belligerent  gorilla,  and  I  said 
to  him,  "Look,  here's  mouse  droppings.   What  the  hell  more  do 
you  want?"  He  said,  "Prove  to  me  that  they  cause  illness."   I 
said,  "I  don't  have  to  prove  a  goddamned  thing  to  you,  mouse 
droppings  aren't  tolerable." 

Well,  he  didn't  take  us  to  court,  but  he  might  have.   He 
was  that  kind  of  a  guy.   He  was  also  president  of  the  hospital 
district-- just  everything.   He  was  a  real  political  animal.   To 
clean  up  San  Pablo,  you  weren't  going  to  get  much  support  from 
people  like  that,  at  that  point.   Well,  we  simply  used  our 
basic  authority,  since  I  was  the  health  officer  for  the  city, 
too. 


Blum:      One  last  episode  about  food  sanitation.   There  was  a  two-story 
Safeway  in  El  Cerrito  that  had  a  bad  manager.   Although  we  had 
closed  a  store  from  every  other  food  chain  at  one  time  or 
another,  Safeway  was  well  above  the  average  and  fixed  any 
violations  as  soon  as  we  spotted  them.   This  store  ended  up 
with  a  burst  sewer  on  the  lower  floor,  and  people  were  getting 
their  milk,  vegetables,  meat  sloshing  through  this  mess.   The 
inspector  gave  them  a  day  or  two  to  get  it  repaired,  came  back 
and  found  it  worse,  if  anything.   He  called  me  down--I  couldn't 
believe  my  eyes--I  would  have  given  them  two  hours. 


152 


We  found  the  manager  and  told  him  that  he  could  put  a 
closed  sign  on  the  door,  and  keep  it  closed  until  we  let  it 
open.   If  he  didn't  wish  to  do  that,  I  would  put  up  our  sign, 
"Closed  by  order  of  the  Health  Officer."  He  squalled  around 
and  when  I  started  to  put  up  our  sign  and  warned  him  that  I 
would  stand  by  and  have  him  arrested  if  anyone  were  allowed  in, 
he  decided  to  be  "closed  for  repairs." 

I  got  back  to  my  office  to  an  earful  of  protests.   The  CEO 
of  Safeway,  who  lived  a  few  houses  from  me,  called  to  demand 
the  store  be  reopened.   And  since  that  wasn't  going  to  happen, 
would  I  hold  the  closure  in  abeyance  until  his  chief  lawyer  got 
back  from  England  where  they  were  just  opening  up  Safeway. 
This  closure  was  a  new  experience  for  them  and  they  were 
mortified  and  furious. 

When  it  settled  down  that  we  meant  business,  they  offered 

to  sue  and  I  told  them  that  that  was  their  prerogative  under 

the  law,  and  we  wouldn't  object,  but  we  did  have  a  lot  of 

photographs  of  what  was  wrong,  and  that  they  might  not  like  the 
protracted  debate  that  would  result. 

This  resulted  in  a  date  for  a  luncheon  the  next  day  at  the 
Safeway  headquarters  in  Oakland,  where  I  met  my  neighbor  for 
the  first  time.   We  had  a  lovely  lunch,  they  got  the  picture, 
and  shortly  thereafter  they  were  back  in  business  in  an 
exemplary  way. 

This  event  became  well  known  for  no  one  had  ever  dared 
close  a  Safeway.   Some  thirty  years  later,  I  was  consulting  for 
the  Contra  Costa  Health  Department  on  a  rather  tricky  issue 
which  involved  about  thirty  prominent  citizens.   As  the  meeting 
got  underway  and  I  was  introduced  by  the  chair,  who  was 
currently  involved  in  the  new  Orinda  Vision  Study  from  UCB  and 
was  most  flattering.   A  husky  female  voice  followed  on  in  the 
pause  in  a  well  heard  aside,  "He's  the  guy  who  closed  a 
Safeway."  That  was  apparently  a  critical  accolade  regarding  my 
credentials. 

1  should  conclude  the  food  sanitation  concerns  with  a  truly 
heartening  tale.   One  stormy  wintry  night  I  was  in  bed  in  our 
Walnut  Creek  home  with  a  good  achy,  fevered,  old-fashioned  flu. 
The  doorbell  rang  at  about  eight-thirty  coincident  with  some 
lightning  and  my  wife  peered  out  to  see  two  huge  men  at  the 
door.   She  cracked  an  adjacent  window  and  asked  what  they 
wanted.   They  announced  that  they  were  the  Burroughs  brothers 
and  had  to  talk  to  the  health  officer.   She  explained  that  I 
was  ill  and  surely  contagious  as  well,  but  that  didn't  bother 


153 


them.   She  cleared  with  me,  brought  two  chairs  into  our 
bedroom,  and  led  them  in. 

I  knew  of  these  men  because  they  ran  the  largest  milking 
herd  in  California  still  in  private  hands,  over  1,000  cows. 
They  were  located  in  the  far  eastern  end  of  the  county  along 
the  Sacramento  River  and  sold  their  milk  under  the  Cloverdale 
brand. 

Their  problem  was  an  odd  one.   Their  longtime  herd  master 
had  left  a  few  years  before  and  had  just  returned.   He  reported 
that  there  were  a  lot  of  cows  with  bloody  urine,  that  there  had 
been  a  drop  in  milk  production  and  a  rise  in  abortions.   These 
were  ominous  findings.   He  had  verified  that  there  was  no 
brucellosis  and  suspected  some  new-fangled  disease  whose  name 
the  brothers  couldn't  remember.   Moreover,  one  of  their 
milkhouse  men  had  just  died  in  the  county  hospital  on  the 
contagious  disease  ward,  cause  unknown.   Their  question:  should 
they  shut  down  the  dairy  that  night  and  start  dumping  the  milk 
until  the  problems  were  clarified,  and  any  suspicion  of  milk- 
borne  disease  laid  to  rest? 

It  so  happened  that  I  was  in  bed  studying  the  latest  on 
leptospirosis ,  a  kind  of  new  infectious  threat  to  cattle  that 
waded  around  in  the  heavily  irrigated  lush  river  valley 
pastures.   I  had  also  taken  care  of  the  man  who  had  died  on  the 
isolation  ward  and  had  sent  specimens  to  Holland  for 
confirmation  of  our  suspicions  of  leptospirosis,  all  of  which 
were  negative  and  his  cause  of  death  remained  unknown. 

This  was  a  predicament.   The  herd  probably  had 

leptospirosis,  but  my  books  didn't  say  whether  it  was  spread  to 
humans  by  cow's  milk,  nor  whether  it  was  clearly  prevented  by 
pasteurization  of  milk.   This  was  now  about  nine  o'clock,  the 
men  were  overwhelmed  that  I  was  studying  their  problem,  but  I 
didn't  have  a  secure  answer  to  what  could  well  be  their 
voluntary  bankruptcy  if  they  shut  down.   The  one  world's 
authority  available  was  K.  F.  Meyer,  a  Swiss  veterinarian  with 
an  honorary  M.D.  who  was  head  of  the  UCSF  Hooper  Foundation,  a 
revered  and  world-famous  scientist  who  had  been  one  of  Bill 
Reeves 's  major  mentors.   I  got  him  on  the  phone  and  in  his 
inimitable  style  he  said,  "You  haf  no  problem,  pasteurization 
will  keep  the  milk  pure,  let  the  dairy  continue  to  operate." 
K.  F.  was  a  fearless  man,  the  most  knowledgeable  person  in  the 
world  on  dozens  of  diseases,  and  perfectly  happy  to  take  the 
responsibility.   The  Burroughs  brothers  were  obviously  happy 
and  then  wanted  to  know  when  we  could  get  going  on  their  cattle 
disease  problem.   Since  we  had  K.  F.'s  ear  there  was  no  doubt 
that  we  could  get  into  it  even  though  we  had  no  lab  of  our  own 


15A 


at  that  time.   As  an  aside,  oil  and  gas  were  shortly  found  on 
the  Burroughs  property,  and  I  can't  think  of  nicer  people  to 
whom  that  could  have  happened. 

K.  F.  Meyer  helped  me  organize  a  meeting  at  the  veterinary 
school  at  UC  Davis  and  we  had  the  State  Departments  of  Health 
and  Agriculture  and  the  federal  USPHS  and  Department  of 
Agriculture.   I  presented  the  problem,  twenty  or  thirty 
employees  and  family  members  whom  I  would  bleed  and  test,  and 
who  would  do  the  1,000  cows?   Nobody  would,  it  seemed.   Yet 
this  was  a  critical  new  problem  in  California.   I  got  disgusted 
and  said  that  we  would  do  it.   A  big  bluff  because  we  didn't 
even  have  a  laboratory,  let  alone  a  fancy  one  to  do  relatively 
new  and  complex  testing.   That  was  too  insulting  for  the  high- 
level  agencies  to  hear  and  resulted  in  a  bidding  war  between1 
them  until  all  parts  of  the  job  were  assigned  and  all  I  had 
left  to  do  was  drawing  the  blood  of  the  people  at  the  dairy. 
This  problem  was  found  to  be  a  huge  one  for  the  cattle  industry 
on  wet  pastures,  but  not  a  human  problem. 

II 

Blum:      We  had  been  very  active  in  setting  up  a  poverty  program  to  give 
folks  a  job  doing  useful  labor,  and  Bill  Martin  got  twenty  or 
thirty  of  those  people  to  work  for  the  health  department.   He 
sat  down  with  them  and  showed  them  how  to  fill  out  an 
inspection  form  as  they  were  close  to  being  illiterate.   He 
took  them  to  different  lots,  and  told  them  what  was  wrong; 
showed  them  what  to  check  on  the  form.   He  had  a  good  touch 
with  them;  he  was  from  Missouri  or  Arkansas,  and  these  people 
were  his  kind  of  people  from  way  back. 

He  taught  them  how  to  do  the  inspections.   We  inspected 
every  house  in  San  Pablo,  found  all  sorts  of  messes;  everything 
was  written  down  and  all  of  them  were  cleaned  up  —  first  time  in 
history.   Nobody  believed  it.   We  had  hearings  for  the  two 
people  that  held  out—that  didn't  get  their  place  cleaned  up  as 
scheduled.   I  sat  there  at  my  big  desk,  and  Bill  ushered  the 
first  one  in.   It  was  a  lady- -very  heavy  and  probably  twenty, 
twenty-five,  just  had  a  baby.   In  the  course  of  that  she  had 
dislocated  an  intervertebral  disc  and  she  had  terrible  sciatica 
pains.   She  came  in  with  tears  in  her  eyes --wouldn't  we  give 
her  time  to  recover  so  that  she  could  clean  her  place  up?   I 
said,  "Well,  sure,"  and  gave  her  all  the  time  she  wanted.   Bill 
found  her  some  help. 

The  next  one  was  a  man  who  had  rheumatoid  arthritis  so 
badly  he  was  scissor-gaited.   I  mean,  his  legs  were  actually 
crossing  one  in  front  of  the  other.   His  hips  were  gone;  and  he 
wasn't  that  old  a  man,  but  he  was  thin  as  a  rail.   He  was  a 


155 


critically  ill  man.   He  too  asked  for  a  few  more  weeks  to  clean 
up  his  yard.   Well,  as  you  think  back  on  it,  if  it  hadn't  been 
for  the  poverty  workers  and  Bill,  we  probably  would  have  been 
shot  as  we  attempted  to  enter  these  places;  but  here  were 
inspectors,  our  poverty  people,  coming  in  to  see  people  who 
were  very  much  their  own  kind.   They  weren't  all  that  hot  on 
reading  and  writing;  they  weren't  college-degreed  inspectors, 
but  they  were  pleasant,  and  they  could  recognize  folks  and 
their  homes  —  their  kind  of  poverty,  their  own  problems,  and 
help  them  solve  their  sanitation  problems. 

Crawford:   Did  you  get  OEO  [Office  of  Economic  Opportunity]  money  for  that 
project? 

Blum:      Yes.   As  the  health  department,  we  were  the  main  figure  in 

writing  up  the  OEO  proposal  for  Contra  Costa  County.   We  spent 
weeks  on  it  and  got  a  huge  grant  but,  interestingly  enough,  I 
went  to  Washington  with  it,  and  Washington  dismantled  the  whole 
thing.   They  said,  "You're  not  doing  it  right."   Well,  we  had 
put  together  monies  for  the  several  ghettos--we  had  Pittsburg, 
Richmond,  and  San  Pablo,  poverty  areas  in  particular  —  and  we 
wanted  money  to  go  to  the  schools,  to  public  works,  and  to 
welfare,  and  for  some  health  things,  and  we  wanted  it  all  to  go 
to  the  same  communities  in  order  to  create  a  significant 
simultaneous  effort.   Washington  said  we  can't  do  that;  we'll 
put  the  school  money  in  this  place,  and  we'll  put  the  welfare 
money  over  in  that  place,  and  the  health  money  over  in  that. 
We'll  divvy  up  the  money,  so  all  the  communities  will  be 
satisfied. 

So,  we  never  had  enough  to  work  with  in  any  one  place  that 
could  train  for  jobs,  put  the  trainees  in  a  job,  get  their  kids 
into  beefed-up  schools  —  feel  the  full  effect. 

Crawford:   Just  fragmenting  everything? 

Blum:      Just  stupid,  but  supposedly  good  for  votes.   I  went  to 

Washington  over  this,  and  I  sat  with  a  bunch  of  hot  shots.   I 
•  took  what  we  used  to  call  the  red-eye  special.   I  remember 
coming  in  there,  dopey  and  sleepy,  to  this  big  meeting.   I  was 
the  only  health  officer  there  from  the  United  States,  and  I 
told  them  that  we  were  just  tired  of  disintegrating.   We  wanted 
to  take  the  kids,  the  parents,  and  the  housing  and  get  it  all 
together  and  fix  the  bad  neighborhoods,  get  folks  going.   But 
doing  it  their  way  when  the  poverty  administrators  got  through 
spending  the  money  there  would  be  a  little  more  for  schooling 
in  one  place,  the  housing  would  be  somewhere  else,  and  the 
parents  who  would  get  jobs  were  from  somewhere  else.   I  thought 


156 


this  was  insane.   Well,  I  was  the  insane  person,  and  that's  the 
way  it  was. 

Crawford:   They  didn't  accept  your  ideas? 

Blum:      No,  politics  is  politics.   They  were  doling  out  money.   They 
wanted  to  spread  it  as  thinly  as  possible.   They  didn't  say 
that.   They  said  widely,  but  it  was  thinly.   In  any  case,  we 
got  a  big  chunk  of  poverty  workers,  and  Bill  used  them  as  I 
described,  and  got  a  job  done  that  you  couldn't  have  done  with 
trained  inspectors.   Nobody  would  have  understood  who  was 
talking  to  whom  nor  why.   Here's  what  a  good  human  being  can 
do--really  pretty  remarkable. 

Crawford:   So  that's  a  major  accomplishment. 

Blum:      Yes,  but  it  was  just  one  man's  dream  that  you  could  do  these 
things  if  you  dealt  with  people  like  people. 


Labor  and  Industry  Politics:  Tidewater  Oil 


Blum:      The  bald  realities  of  crummy  politics  were  charmingly  presented 
by  some  of  the  less  usual  but  not  rare  occurrences.   One  was 
created  by  Tidewater  Oil,  also  known  as  Associated  and  now  a 
part  of  Tosco.   In  anticipation  of  selling  out  it  was 
neglecting  its  still-operating  old  plant  just  to  the  east  of 
Martinez.   One  day  we  got  a  call  from  a  group  of  Port  Chicago 
householders  just  downwind  of  Tidewater,  that  several  horses, 
sheep,  and  goats  had  just  died  and  that  paint  was  pitting  on 
cars  that  had  been  left  parked  outside. 

Inspectors  took  hold,  verified  the  report,  and  gathered  a 
lot  of  plant  material  on  which  the  animals  had  been  feeding  for 
analysis.   It  should  be  noted  that  herbivores  would  perish 
first  as  their  diet  was  principally  the  vegetation  on  which 
toxics  had  settled  out.   By  this  time  we  had  an  excellent  lab 
and  soon  determined  that  contrary  to  our  expectations  of  acidic 
sulfur  compounds,  the  culprit  was  arsenic.   Fortunately,  our 
industrial  engineer  had  a  hobby  of  keeping  track  of  who  bought 
arsenic  and  other  dangerous  chemicals  in  large  quantities. 
Tidewater  used  arsenic  as  a  catalyst  in  its  cracker.   However, 
the  catalyst  supposedly  remains,  but  Tidewater  obviously  was 
losing  it  and  thus  using  large  amounts,  a  pretty  callous 
performance.   We  also  had  a  wind  recorder  in  operation  nearby 
that  showed  day  after  day  prevailing  winds  from  the  plant 
directly  targeting  the  homes  affected. 


157 


Interestingly  enough,  the  Monsanto  plant  adjacent  had  a 
sulfuric  acid  pipe  failure  at  the  same  time.   They  had  a 
somewhat  different  outlook  on  how  to  live  with  their  neighbors 
and  had  already  sent  their  insurance  people  out  to  obtain  and 
pay  claims  for  damages  they  mistakenly  thought  were  due  to 
their  breakdown.   All  this  was  very  confusing  for  the 
householders  and  we  called  a  town  meeting  for  the  next  evening. 
I  presided,  giving  out  what  we  knew  for  sure,  including  the 
wind  data,  which  was  pretty  irrefutable.   Monsanto  turned  out 
as  the  good  guys,  but  Tidewater  showed  up  in  force  and  made  it 
clear  that  the  health  officer  was  an  illiterate  M.D.  and 
refused  to  take  any  further  part  in  discussions  or 
clarifications  about  what  had  to  happen. 

That  did  annoy  me,  an  erstwhile  chemist,  to  hear  them  make 
up  arrant  nonsense,  as  well  as  denounce  the  health  department. 
So  I  put  a  letter  on  the  board  of  supervisors'  desk  first  thing 
next  morning,  asking  for  a  public  hearing  on  Tidewater's 
negligence,  threat  to  health,  and  dishonesty.   Anything  on  the 
board's  blotter  is  public  business  and  they  had  no  escape 
because  my  written  request  for  a  hearing  was  a  prompt  media 
event.   The  board  set  a  hearing  for  a  couple  days  hence.   That 
night  I  got  a  call  from  the  president  of  the  Chemical  and  Oil 
Workers  Union,  a  so-called  liberal  union,  asking  me  to  back  off 
because  this  might  hurt  Tidewater  and  thus  his  union  members 
who  worked  there.   I  countered,  asking  if  his  members  might  not 
be  hurt  if  we  backed  off,  since  some  of  them  lived  exactly  in 
the  area  affected. 

However,  the  union  head,  who  was  at  that  very  time  chairman 
of  the  Civil  Service  Commission,  told  me  that  he  was  sorry  that 
I  was  unaware  that  our  department  had  several  matters  of  salary 
rectification  coming  up  before  the  commission  at  their  very 
next  meeting  and  that  it  would  be  unfortunate  if  our  employees 
didn't  get  what  they  deserved.   Apparently,  his  union  was  only 
modestly  if  at  all  interested  in  the  fair  treatment  of  working 
people  other  than  their  own.   In  any  case,  I  made  it  clear  that 
there  was  no  turning  back,  and  that  we  had  all  the  evidence 
lined  up  for  the  hearing. 

When  the  hearing  opened,  I  presented  the  situation  to  a 
sizeable  crowd.   The  first  witnesses  to  be  called  were  the 
union's  representatives  who  in  an  embarrassingly  stupid  way 
denied  any  possibility  that  Tidewater  could  be  at  fault.   The 
second  witness  was  the  Tidewater  P.R.  man,  a  harmless  guy,  who 
made  two  points  clear.   The  first  was  that  it  couldn't  possibly 
be  Tidewater's  doing,  and  the  second  was  that  Tidewater  had 
found  the  problem,  that  it  had  been  fixed,  and  that  they  would 
make  sure  it  never  happened  again. 


158 


I  don't  believe  that  our  employees  were  ultimately 
penalized  for  having  a  politically  inept  boss. 


Growing  Wild  in  Contra  Costa;  More  about  Sewers  and  Other 
Amenities 

[Interview  4:  March  21,  1997]  ti 


Crawford:   When  we  started  talking  about  your  work  as  health  officer  you 
said,  "Contra  Costa  County  was  just  one  ethical  issue  after 
another. " 

Blum:      All  health  departments  face  one  ethical  dilemma  after  another. 
Contra  Costa  was  no  exception. 

The  sanitation  situations  taught  me  a  lot  about  practical 
ethics,  but  primarily  in  retrospect.   That  is  an  interesting 
sphere.   Most  of  what  you  do  in  sanitation  is  to  carry  out 
state  laws:  the  health  and  safety  code  has  hundreds  and 
hundreds  of  pages  of  what  you're  supposed  to  do.   Of  course, 
you  don't  have  the  personnel  or  payroll  to  do  these  things,  but 
you  do  whatever  you're  forced  to  do  whenever  the  situation's  a 
bad  one.   So  you  do  something.   In  some  health  departments,  if 
the  situation  is  bad,  the  practice  is  to  look  for  another  page, 
and  to  stay  away  from  this  portion  of  the  health  and  safety 
code . 


Contra  Costa  went  from  probably  120,000  people  before  the 
war  to  over  300,000  by  1950.   It  was  a  wild  growth  scene.   When 
I  got  there  in  1950,  the  population  was  made  up  mostly  of  young 
families—the  new  population.   People  were  moving  out  there  to 
a  bedroom  community.   There  was  a  fair  bit  of  commuting  back  to 
jobs  in  San  Francisco  and  the  East  Bay,  and  a  fair  number  of 
new  jobs  were  being  created  out  there. 

One  of  the  things  that  didn't  strike  me  until  later--! 
don't  know  whether  it's  an  ethical  issue  or  not,  but- -we 
typically  forced  the  farmers  to  give  up  their  land  by  allowing 
subdivisions.   Then  the  farmers  couldn't  resist  the  new  land 
values.   In  turn,  their  property  taxes  went  up  and  farmers 
couldn't  face  them.   So  high  land  taxes  and  higher  land  values 
forced  or  encouraged  more  and  more  farmers  to  sell  for 
development.   So,  when  there  is  rampant  subdividing,  you 
automatically  flooded  the  soils  with  gardening  irrigation  and 
all  the  waste  from  septic  tanks,  because  there  weren't  sewers 
in  this  backwoods  country. 


159 


Crawford:   It  was  done  so  quickly? 

Blum:      Yes.   You  couldn't  get  sewers  in  to  begin  with.   You  have  to 
have  somebody  to  vote  for  the  sewers.   You  have  to  have 
sufficient  value  to  the  property.   You  can't  sell  bonds  unless 
you've  got  something  of  value.   So  first  the  community  builds 
to  get  the  bond  value,  and  then  it  sells  bonds,  and  then  you 
put  in  the  sewers  after  you've  already  built  the  roads  and  the 
houses  and  septic  tanks.   The  whole  process  is  all  backwards, 
but  there's  a  reason  for  it.   If  you  drove  to  Oceanside  in 
years  gone  by,  you  saw  streets  all  laid  out,  with  lampposts, 
and  the  sewers  all  in- -but  no  houses.   That  went  on  for  thirty 
years.   Somewhere  in  the  late  twenties,  somebody  decided  to  do 
it  right,  and  they  put  in  all  the  infrastructure,  but  then 
there  was  the  Depression,  and  nobody  could  build.   So  here  were 
these  tremendous  numbers  of  improvements  at  great  cost,  but  no 
people  to  help  defray  those  costs. 

Crawford:   So  that  you  jumped  into  the  middle  of  an  expanding  situation. 

Blum:      When  an  area  first  develops  out  of  a  rural  setting,  there  is  a 
near  inevitable  progression.   People  buy  a  piece  of  land  and 
expect  and  want  to  build  on  it.   There  are  no  sewers  to  connect 
to  so  they  seek  a  building  permit  which  requires  a 
"satisfactory"  scheme  of  disposing  of  liquid  wastes  and  sewage. 
The  first  step  is  to  get  soil  absorption  or  percolation  tests, 
a  rough  scheme  to  tell  if  water  from  a  septic  tank  can  be 
distributed  over  the  part  of  the  land  not  to  be  built  upon,  and 
kept  from  surfacing  by  means  of  underground  drain  lines  of 
specified  length. 

The  tests  are  done  after  the  rainy  season  is  past  so  that 
the  soil  will  take  more  moisture.   If  the  results  are  favorable 

and  if  an  appropriate  septic  tank  and  drain  fields  are 
designed,  a  permit  is  given. 

Some  soils  are  marginal,  some  are  a  bit  marshy  if  there  has 
been  a  good  wet  season.   But  what  is  worse,  as  lawns  and 
gardens  get  planted,  they  are  irrigated  and  much  of  a  lot  can 
be  saturated  that  way.  All  adjacent  lots  have  the  same  fate 
and  the  whole  area  can  become  waterlogged. 

Then,  toilets  won't  flush,  the  drain  fields  overflow,  and 
people  live  in  a  daily  nightmare  of  sewage,  sometimes  for 
months  on  end  or  permanently.   You  just  can't  appreciate  the 
misery  of  a  family  in  a  new  home  that  becomes  almost  unlivable. 
And  most  people  are  from  a  city  home  where  such  problems  never 
existed  for  more  than  a  few  hours  and  are  corrected  promptly. 


160 


Such  a  neighborhood  comes  to  a  rebellious  state  of  affairs 
and  the  health  department  preaches,  "Let  us  bring  in  sewers." 
But  sewers  need  treatment  plants  and  an  ultimate  discharge 
point  for  the  treated  sewage,  i.e.,  a  bay,  a  river,  sometimes  a 
lake  in  a  pinch.   The  costs  are  huge.   A  majority  of  the 
property  owners  have  to  vote  in  favor  of  the  proposal  and 
accept  the  taxes  that  go  to  pay  off  the  long-term  tax-exempt 
bonds  that  are  used  for  financing.   If  there  aren't  enough 
property  owners,  the  costs  to  an  individual  householder  are  too 
high. 

Large  developers  tend  to  do  all  this  in  advance,  but  not 
all  neighborhoods  lend  themselves  to  large  developments. 
Contra  Costa  had  hundreds  of  septic  tanks,  and  at  some  point 
the  misery  boils  over  and  there  comes  a  sorting  out  among 
property  owners.   If  not  enough  of  them  join,  there  won't  be 
enough  property  to  justify  the  bonds  needed  for  the  sewage 
disposal  machinery  and  pipelines. 

Today  when  cities  and  counties  have  matured,  they  demand  in 
advance  that  subdivisions  provide  not  only  streets  but  all  the 
utilities  as  part  of  their  package.   Even  parks,  space  for 
public  buildings,  and  schools  are  typically  part  of  the 
package. 

Should  I  have  made  a  career  of  fighting  for  such  more 
mature  ways  of  doing  development?   I  didn't,  never  saw  it  in 
that  light.   Would  I  have  accomplished  anything  in  the  sense  of 
getting  a  more  reasonable  set  of  outcomes  earlier,  or  did  our 
approach  of  fixing  bad  situations  lead  to  the  better  current 
practices  anyway? 

Typically,  the  sanitary  districts  that  would  have  to 
provide  these  services  would  either  run  an  election  and  see  who 
voted  against  it,  or  they  would  go  from  door  to  door  in  advance 
and  find  out  who  was  going  to  be  against  it.   Then  they  drew 
new  district  boundaries  which  left  out  people  who  were  against 
it  up  to  the  point  where  the  majority  left  in  the  district 
would  vote  for  it.   The  word  gerrymander  really  came  into  its 
own.   You  might  have  a  cherry  stem- -meaning  that  up  to  a  point, 
all  landowners  want  it,  and  from  here  on  there's  a  mile  along  a 
road  where  nobody  wants  it.   So  the  district  boundaries  run 
down  the  road.   When  the  district  comes  to  another  batch  of 
property  owners  who  want  the  district's  services,  the 
boundaries  extend  once  more  and  take  them  in.   The  district  is 
cherry-stemmed  and  gerrymandered  by  this  maneuver. 

Crawford:   The  supervisors  were  doing  that? 


161 


Blum:      Not  the  county  board  but  the  sanitary  district  boards. 
Crawford:   Somebody  must  have  been  making  a  tremendous  amount  of  money. 

Blum:      Yes,  developers  and  labor  and  all  the  businesses  that  sold  to 
them,  but  that  isn't  really  the  issue.   After  a  certain  point 
when  septic  tanks  can  no  longer  be  tolerated,  you  have  to  build 
sewers.   By  then  there  are  a  whole  bunch  of  vested  interests 
who  are  now  living  there.   Once  an  area  starts  developing,  the 
health  officer  is  key  in  signing  all  the  papers  and  agreeing 
that  yes,  new  developments  are  safe  and  sanitary  when  they  have 
safe  water  and  safe  sewage  disposal.   The  value  of  the  land 
adjacent  also  goes  up  so  the  farmers  can't  afford  to  stay  there 
as  farmers,  and  they  too  will  vote  for  new  utilities. 

Crawford:   Were  you  pressured  to  do  this? 

Blum:      No,  not  pressured  in  a  direct  sense,  but  indirectly,  yes, 

because  you  have  no  choice.   If  people  are  flooded  with  sewage, 
the  health  department  has  to  press  for  sewers,  because  this  is 
a  dangerous  situation  for  all  people  in  the  area  and  a  truly 
miserable  one  for  people  who  can't  use  their  plumbing. 

Crawford:   Did  you  eventually  get  the  situation  turned  around? 
Blum:      Yes,  you  eventually  always  end  up  getting  the  sewers. 
Crawford:   What  happened  in  that  subdivision? 

Blum:      Oh,  that  one  with  the  ersatz  septic  tanks?  The  sewers  came  in 
ultimately,  there  was  a  sanitary  district  to  accept  this 
sewage. 

Crawford:   It  wasn't  a  disaster? 

Blum:      It  wasn't  a  total  disaster,  but  it  cost  householders  extra 
money.   You  build  a  septic  tank--junk--and  then  you  have  to 
throw  it  away.   And  you  also  have  to  cut  up  the  streets  to  put 
in  sewers  later  on,  and  pay  for  their  repair,  but  there  are  no 
options.   Practically  no  options. 

The  Orinda  community  was  very  hard  to  sewer--big  lots,  very 
expensive.   The  Contra  Costa  Central  Sanitary  District  runs  a 
sewer  line  from  Orinda  out  to  Martinez  to  the  waterfront  where 
their  plant  is.   That  cost  a  fortune.   They  couldn't  sell  bonds 
on  empty  land.   So  it  was  developed- -a  little  piece  here,  a 
little  piece  there—then  finally  it's  developed  and  produces  a 
mess  of  sewage.   Then  the  health  department  says,  "Well,  folks. 
You've  got  to  get  sewers."  Some  of  the  devices  that  are  used 


162 


are  that  the  health  department  doesn't  permit  new  schools,  or 
further  new  construction.  Well,  everybody  that's  involved  in 
this  place  suddenly  decides  that  they've  got  to  have  sewers. 

Crawford:   And  this  is  your  decision  as  health  officer? 

Blum:      In  a  sense,  the  health  officer's  always  pushing  it.   All  of  a 
sudden,  you  realize  that  you're  the  king  of  the  developers 
without  meaning  to  have  anything  to  do  with  it.   In  fact, 
you're  forcing  it. 

Crawford:   You  must  have  had  feelings  about  that? 

Blum:      You  finally  do.   But  it  was  many  years  before  I  saw  that  I  was 
the  key  facilitator  of  this  badly  functioning  scheme  for 
development.   As  I  look  back,  I  don't  know  whether  you'd  say 
it's  ethical  or  unethical.   The  crux  of  the  matter  is  that  our 
society  has  no  method  of  doing  development  sensibly. 

Crawford:   So,  in  balance,  how  did  you  feel  about  your  dealings  with  this 
issue? 

Blum:      One  always  ended  up  saying,  "There's  no  choice."   It's 
happening,  and  so  we  have  to  improve  the  situation. 

Central  Sanitary  District  started  out  with  an  eight-inch 
line  from  Orinda  to  Martinez,  but  within  a  couple  of  years,  an 
eight-inch  line  wasn't  adequate.   Then  you  need  a  two-foot 
line.   So  you  tear  up  the  whole  highway  again- -and  the 
taxpayers  are  paying  for  this.   Then  people  are  able  to  build 
further  up  the  hillsides  because  of  the  bigger  sewer,  and  in  a 
decade  you  may  need  a  six-foot  line. 

Highway  24  was  torn  up  all  the  years  I  lived  there.   First 
you  had  a  little  sewer,  then  you  had  a  bigger  one.   Then  EBMUD 
needed  a  larger  water  line,  and  then  BART  came  in,  and  that 
tore  it  up  again  for  a  couple  more  years.   People  never  had  a 
decent  road.   Highway  24  was  a  disaster,  always  and  forever; 
and  always  because  there's  no  way  of  building  what  is 
ultimately  needed  to  begin  with.   You  can't  put  up  the  money  in 
advance  when  nobody  will  float  those  bonds,  and  if  there  isn't 
anybody  to  use  the  facilities,  you  really  are  speculating. 
Well,  there  are  very  few  places  in  the  world  that  can  handle 
that  sort  of  thing. 

Crawford:   Who  handles  it  best? 

Blum:      Well,  as  you  can  imagine,  Sweden.   In  Stockholm,  the  city  went 
out  and  simply  acquired  all  the  peripheral  land,  and  then  said, 


163 


"This  is  how  it  will  be  developed.   When  we  decide  it  will  be 
developed,  we'll  put  in  transport,  we'll  put  in  water  and 
utilities  and  sewers."  But  even  in  Sweden,  this  didn't  always 
work  well  because  of  political  decisions.   It's  been  kind  of 
shaky  and  not  every  city  in  Sweden  did  it.   Britain  tried  to  do 
it,  but  could  not  control  planned  development  well  because  the 
games  that  are  to  be  played  with  real  estate  are  monstrous. 
Millionaires,  billionaires  are  made  out  of  these  things. 

It  was  kind  of  interesting.   Over  in  the  west  side  of 
Contra  Costa  County,  there  were  a  lot  of  bad  areas  with  homes 
on  septic  tanks  that  we  had  approved.   The  net  result  was  that 
there  were  great  slippages;  houses  slipped  after  a  big  rain. 

In  west  Contra  Costa  the  El  Sobrante  area  was  swimming  in 
sewage.   It  was  horrible.   All  of  a  sudden,  we  had  a  few  cases 
of  little  children  with  dysentery.   You  wonder,  but  you  can't 
prove  it  is  the  sewage,  but  it's  very  suspicious.   Of  course, 
sewage  carried  polio,  hepatitis,  and  other  infections. 

I  remember  we  had  a  sewer  bond  election- -which  is  the 
prelude  to  getting  the  sewer--and  it  turned  out  that  everybody 
in  the  El  Sobrante  area  would  be  against  it.   I  discovered  who 
the  key  figures  were,  and  phoned  from  my  desk  in  Martinez  to  a 
man  who  was  the  president  of  the  overall  association  of  all  the 
El  Sobrante  community  organizations.   There  were  twenty-three 
of  them.   He  was  also  the  president  of  three  or  four  of  the 
twenty-three  organizations.   He  was  an  upholsterer. 

I  got  him  on  the  phone,  told  him  who  I  was,  and  said,  "You 
know,  you've  got  a  big  problem  there.   I  gather  you're  leading 
the  movement  to  fight  the  sewers.   I  think  you're  making  a  big 
mistake  because,  in  the  first  place,  you  can't  build  a  new 
school  there.   We're  not  going  to  sign  for  it  because  it's 
going  to  be  swimming  in  sewage.   There's  no  way  of  getting  rid 
of  the  sewage  properly,  and  we  won't  permit  any  new 
construction.   El  Sobrante' s  a  growing  area,  and  we  simply 
won't  sign  off  on  new  construction  because  you're  swimming  in 
sewage .   So  let  me  come  down  and  draw  you  some  pictures . " 

His  response  was  very  typical,  as  it  turns  out.   He  said, 
"Well,  now,  Doctor,  I'll  come  up  and  see  you  in  Martinez."   I 
said,  "Oh,  no,  no.   There's  no  reason  for  that.   This  is  my 
job,  and  I'll  come  down  and  talk  to  you."  He  said,  "Oh,  no, 
no.  You're  too  important.   I'll  come  up  and  talk  to  you." 
Well,  my  logic  was,  "Okay,  I'm  not  going  to  fight  the  man  over 
this.   If  he  wants  to,  and  it  makes  him  feel  better,  I'll  let 
him  come  to  Martinez." 


164 


This  is  how  that  battle  was  won.   You  knew  that  you  had  the 
battle  won  when  this  man  insisted  he  would  come  to  see  you 
because  you  were  important.   This  is  an  interesting  kind  of 
dynamic.   So  he  was  in  my  office  in  a  matter  of  hours.   I 
explained  the  whole  picture  to  him,  how  they  couldn't  get  a  new 
school  which  they  needed. 

Crawford:   Who  was  he? 

Blum:      Oh,  he  was  an  upholsterer,  with  a  small  business,  and  he  was 
probably  the  president  of  the  chamber  of  commerce,  as  well  as 
the  president  of  the  association  of  all  twenty-three  community 
organizations. 

Crawford:   Why  didn't  he  want  sewers? 

Blum:      Because  it  meant  taxes  he  and  all  the  other  residents  would 

have  had  to  pay.   It  would  make  his  business  and  his  home  more 
expensive  to  maintain,  but,  on  the  other  hand,  his  whole  future 
was  tied  up  in  the  community's  growth  so  his  upholstery 
business  would  grow.   All  of  his  buddies  are  in  business.   The 
folks  who  are  key  in  this  are  typically  small  businessmen. 

Crawford:   So  there  weren't  any  big  developers  who  were  reaping  big 
financial  rewards? 

Blum:      No,  it  wasn't  that  kind  of  a  place.   It  was  just  little  people. 
So  we  sat  and  chatted  for  a  while,  and  I  said,  "As  I  see  it, 
from  where  I  sit,  you'd  be  better  off  paying  some  more  taxes 
and  getting  in  sewers,  and  getting  a  new  school,  and  allowing 
developers  to  build,  and  letting  the  place  grow.   Is  that  what 
you  want?"   It  sure  was.   He  said,  "Well,  I  didn't  really 
understand  all  this." 


He  went  home,  and  late  that  night  I  got  a  phone  call  from 
him.   All  twenty-three  organizations  had  already  met  that 
evening.   They  had  reversed  their  position,  and  they  were  now 
in  favor  of  the  sewers.   That  sewer  bond  went  through  with  over 
an  85  percent  positive  vote-- just  unheard  of. 

Crawford:   So  there  was  finally  some  well-planned  development  in 
connection  with  that  issue? 

Blum:      Well,  not  really—unless  you  think  unplanned  development  is 

necessarily  good,  then  we  did  it.   But  if,  on  the  other  hand, 
you're  not  so  sure  about  helter-skelter  development,  which  it 
was,  in  the  sense  that  people  are  speculating  on  creating 
various  usages  scattered  over  miles,  then  it's  not  well-planned 
development.   So  we  often  push  the  community  into  becoming  a 


165 


modest  disaster  area,  but  possibly  better  than  the  one  they 
were  already  in.   Well,  this  sort  of  thing  just  goes  on  and  on. 

Crawford:   Are  you  working  around  shady  practices? 

Blum:      Well,  these  are  not  shady  practices.   These  are  political 

reality  aspects  of  growth.   These  are  issues  that  our  society 
has  never  decided  to  settle.   Patchwork  is  how  they  get 
settled.   A  health  officer  gets  used  to  making  case-by-case 
decisions  without  having  a  satisfactory  overall  scheme  to  go  by 
until  his  community  develops  and  legalizes  specific  standards 
on  how  things  are  to  be  done. 

In  one  Walnut  Creek  area,  we  had  the  same  sort  of  battle, 
and  lo  and  behold,  who's  against  the  sewer?  A  couple  of 
physicians.   They  happen  to  own  property  and  buildings,  and 
they  are  going  to  face  more  taxes,  and  they  don't  want  to; 
also,  they  have  no  problem  themselves.   These  situations  can  be 
fun  because  you  go  to  a  public  meeting  where  the  physician  gets 
up  and  makes  a  speech,  and  you're  also  a  physician  and  have  to 
take  up  the  opposite  side  of  the  issue. 

I  remember  the  Walnut  Creek  debate.   The  physician  was  a 
fairly  young  man.   I  said  to  the  attendees,  "Let  me  tell  you 
about  the  health  side,  which  the  doctor  doesn't  seem  to  care 
very  much  about." 

Crawford:   These  would  be  public  meetings? 

Blum:      Public  meetings,  and  the  doctor  commenced  to  look  like  a  bum. 

Here  he  is,  worried  about  his  taxes—which  aren't  all  that  bad, 
and  he's  making  a  good  living—and  the  health  officer  is 
concerned  about  getting  rid  of  sewage  out  of  schoolyards,  and 
sewage  out  of  backyards,  that  sort  of  thing.   Your  medical 
opponent  creeps  away,  and  you're  so  very  virtuous,  even  if  you 
helped  the  neighborhood  get  into  its  mess  to  begin  with  by 
okaying  some  development  on  septic  tanks  which  you  knew 
couldn't  hold  up,  no  matter  how  well  they  complied  with  the 
regulations  when  they  built. 

You  could  really  question  the  ethics  of  all  that  behavior. 
Yet  no  health  officer  could  have  stopped  the  initial 
development;  people  had  a  right  to  use  their  land,  as  he  would 
soon  find  out.  And  you  can  question  my  ethics  here,  and  do  a 
good  job  on  it,  too. 

Crawford:   Why? 


166 


Blum:      Well,  because  here  I'm  taking  advantage  of  a  situation  to  make 
this  guy  look  like  a  jerk,  particularly  because  he's  a  doctor. 

Crawford:   He  is_  a  jerk. 

Blum:      Yes,  he  is  a  jerk,  but  only  because  he  is  unsophisticated  about 
the  origins  of  the  problem,  which  neither  he  nor  I  nor  the 
community  will  set  right  for  the  long  term. 

I  bought  a  house,  which  was  finished  within  a  month  or  two 
of  the  time  I  bought  it.   It  was  in  an  old  neighborhood,  a  nice 
neighborhood  called  Upper  Lakewood  in  Walnut  Creek.   And, 
little  realizing—well,  I  guess  I  did  realize—that  the  road 
was  not  a  public  road;  it  was  a  private  road.   The  water  system 
was  a  private  water  system  although  it  was  in  the  middle  of 
East  Bay  MUD  territory  but  still,  a  private  water  system. 
There  was  no  maintenance  for  the  roads,  no  maintenance  for  the 
water  system.   So  one  moves  into  a  situation  like  that.   There 
were  sewers,  thank  god. 

We'd  no  more  than  moved  in  when  roads  and  water  system 
started  falling  apart  in  the  whole  neighborhood,  and  everybody 
came  to  me:  "You're  the  health  officer.   Fix  it!   Make 
something  happen,  it's  unhealthy." 

I  said,  "But  I  don't  run  the  roads  department.   The  road  is 
owned  by  us.   You  can't  ask  the  county  to  fix  this  road,  we  own 
it."   So  there  were  long  negotiations,  but  always  with  me  in 
the  middle  of  this  stupid  mess  because  I  am  the  county  health 
officer.   Finally,  all  of  us  put  up  enough  money,  and  paid  the 
county  to  come  in  and  take  care  of  the  roads. 

Crawford:   You  did? 

Blum:      All  the  owners  did.   Come  Saturday  afternoon,  everybody  is 

getting  cleaned  up  — I  presume  that  was  what  was  going  on— and 
there  would  be  no  water.   You  turn  on  the  faucets,  and  the 
faucets  are  gasping.   Yet  there  is  this  big  water  tower  that 
everybody  in  the  neighborhood  could  see,  up  on  a  high  piece  of 
land,  which  was  our  water  storage  facility. 

Crawford:   But  you  couldn't  buy  into  that? 

Blum:      Well,  it  was  ours,  but  it  turns  out  that  the  man  whose  house 

was  adjacent  to  it  would  turn  off  the  water  for  the  rest  of  the 
community  so  that  he  could  have  water.   It  was  just  a  limited 
amount  of  water. 

Crawford:   And  he  was  part  of  your  private  enclave? 


167 


Blum:      Yes!   He  was  just  one  of  us,  but  who's  going  to  go  up  there  and 

hit  him  over  the  head  with  a  wrench  and  open  that  tap?  It 

doesn't  work  that  way.   So  we  had  these  big  meetings  —  a  couple 

hundred  people.   People  would  bring  their  kids.   It  was  a  real 

picnic,  but  it  was  also  serious  because  people  couldn't  get  any 

water  to  flush  their  toilets,  take  a  bath,  particularly  on 
weekends . 

I  remember  one  of  these  meetings.   There  was  a  resident  who 
was  a  bakery  driver—kind  of  a  red-faced  fellow,  cute,  nice. 
His  wife  was  a  cherubic,  red- faced,  little  lady,  and  they  had  a 
couple  of  cute  little,  cherubic,  red- faced  children.   They'd 
all  come  to  the  meetings  and  sit  there  and  kind  of  chat  at  one 
another  in  a  nice  way.   The  president  of  our  neighborhood 
association  opened  up  the  meeting  about  the  water  problem.   We 
had  no  more  than  started  when  some  man  raised  his  hand,  he 
wanted  to  speak,  and  it  was  the  man  who  controlled  the  water 
tower,  who  had  the  knobs  under  his  thumb. 


Crawford: 


Blum: 


The  chairman  said,  "This  is  Mr.  So-and-so,"  and  this  little 
red-faced  bakery  guy  jumps  up  and  says,  "So  that ' s  Mr.  So-and- 
so."  Well,  the  audience  got  hysterical  because  they  all  knew 
the  name  of  the  villain  but  didn't  know  him.   That  just 
completely  wiped  out  the  credibility  of  this  man,  settled  his 
hash  once  and  for  all.   He  never  even  said  a  word.   He  sat 
down. 

Then  we  got  into  the  business  of  discussing  a  new  water 
system.   "This  is  going  to  cost  this  much  and  that  much;  and 
what's  the  old  system  worth?"  Well,  it  wasn't  worth  a  damn  at 
best.   I'm  sitting  there,  cringing  all  the  while,  because  the 
health  officer  is  supposed  to  be  guaranteeing  that  you've  got 
clean  water  where  you  live,  and  up  gets  a  lady  who  sort  of 
hysterically  is  saying,  "This  water  system  is  worth  thirty, 
fifty,  no,  seventy  thousand  dollars."  The  bakery  man  calls 
out,  "Sold!"  That  was  the  end  of  that.   [laughs]   The  meeting 
dissolved  peacefully,  everybody  put  up  their  money,  shut  up, 
and  we  bought  into  East  Bay  MUD. 

Is  that  considered  elitist,  when  you  live  in  these  private 
enclaves? 

Perhaps  it  was.   The  bad  roads  and  decrepit  water  system  could 
have  been  the  result  of  speculation,  or  in  our  case  an  example 
of  how  little  even  well-off  homeowners  really  understand  about 
what  they  are  getting  into  when  they  choose  a  homesite.   I  sort 
of  knew  what  I  was  getting  into.   It  was  a  lovely  house  by  a 
fine,  careful  builder,  with  good  neighbors;  not  small  matters. 


168 


Crawford:   Who  was  the  architect? 

Blum:      I  don't  think  there  was  any  professional  architect.   The 

builder's  wife  was  the  architect.   She  was  a  fun  lady.   They 
lived  just  across  the  street  from  us.   We  always  got  along 
well.   He  did  beautiful  work.   His  name  was  Curt  Muller.   He 
was  a  subdivider,  too;  lived  there  for  fifteen  or  sixteen  years 
until  he  had  built  on  all  the  parcels  he  owned. 

The  bakery  truck  driver,  whom  you  wouldn't  think  of  as 
being  the  great  solver  of  problems,  got  rid  of  the  old  rascal 
who  used  to  screw  up  our  water  system;  got  rid  of  the  lady  who 
was  getting  hysterical  about  how  valuable  our  present  junk 
system  was.   That  must  have  been  the  tenth  meeting  we  had,  and 
if  it  hadn't  been  for  this  driver,  we'd  have  had  ten  more. 

Crawford:   What  were  the  forces  out  there?  You  said  that  labor  was  very 
strong? 

Blum:      In  a  situation  like  that,  labor  was  irrelevant.   It  was 

strictly  a  problem  for  the  homeowners.   The  developers  would  be 
on  the  side  of  fixing  things  because  they're  going  to  sell,  but 
there  weren't  many  big  developers.   Our  builder  was  one  of  the 
many  small  ones.   They  built  four  or  five  homes,  ten  homes  at 
the  most.   So  it  was  no  big  deal.   There's  nobody  to  bribe; 
there's  just  a  past  history  of  doing  your  own  thing  until  the 
mix  got  intolerable. 


A  Privately  Owned  Development;  A  Municipal  Utility  District 


Blum:      One  special  developer  came  into  the  county.   He  and  his  mother 
and  father  got  their  hands  on  a  huge  piece  of  land—thousands 
of  acres.   This  land  surrounded  the  Mt.  Diablo  Country  Club. 
That's  a  nice  spot  with  a  large  golf  course.   The  developer 
formed  a  district,  a  municipal  utility  district—just  these 
three  people  governed  it—and  it  had  as  much  legal  standing  as 
East  Bay  MUD.   They  did  whatever  they  felt  was  necessary,  and 
they  wrote  their  own  sanitary  laws.   The  only  people  who  had 
any  supervision  over  them  at  all  was  the  state  health 
department.   We  could  go  and  admire  and  scream,  but  the  county 
health  department  had  nothing  to  say  about  it. 

fi 

Blum:      They  were  going  to  build  several  hundred  homes,  and  they  built 
at  least  fifty  to  begin  with.   The  sewage  all  ran  by  gravity 


169 


down  to  a  big  sump.   There  they  had  big  pumps  which  pumped  the 
sewage  back  up  to  the  top  of  the  mountain  behind  the  Diablo 
Country  Club.   There  they  had  built  a  huge  dam  to  hold  the 
sewage.   Around  the  perimeter  of  the  dam  they  had  a  pumping 
system  with  sprays  so  that  the  sewage  was  sprayed  up  in  the  air 
to  evaporate,  and  the  State  Health  Department  approved  this-- 
the  last  word  in  modern  something  or  other. 

We  were  pretty  sure  it  was  a  disaster  area.   It  turned  out 
that  these  subdividers,  who  were  totally  unscrupulous,  used  a 
six- inch  pipe  to  pump  the  sewage  up  to  the  top  of  the  mountain 
--it  was  about  a  mile—and  they  used  second-hand  invasion  pipe, 
which  had  been  through  the  war  in  Europe.   It  wasn't  very  good, 
[laughter] 

Crawford:   Is  piping  that  expensive? 

Blum:      Oh,  yes,  it  costs  a  fortune;  and  this  stuff  was  the  cheapest 

kind  to  begin  with-- just  for  the  invasion  of  Normandy.   Then  it 
was  brought  back  to  the  United  States,  and  this  outfit  used  it 
to  pump  sewage  up  a  mountain.   They  also  had  inadvertently  put 
the  big  pumps  in  on  a  slant  so  that  the  bearings  burnt  out 
every  few  days  and  the  pumping  system  would  come  to  a  halt. 
Then  they  would  put  in  new  bearings,  which  might  take  a  week  or 
two  or  three.   The  people  who  set  it  up  now  were  out  of  it. 
The  folks  who  were  stuck  with  it  were  the  members  of  the 
utility  district,  meaning  the  folks  who  bought  homes  there. 
The  developers  settled  in  Australia  with  which  we  have  no 
extradition  treaty. 

Crawford:   They  were  criminals,  basically? 

Blum:      Yes. 

Crawford:   But  the  state  was  passing  it? 

Blum:      Passed  it.   They  probably  had  over  fifty  homes  built.   They 

were  inexpensive  in  those  days;  $8,000  for  a  home.  Most  folks 
could  afford  one  by  getting  a  near  total  mortgage.   It  was  a 
lovely  spot,  overlooking  the  country  club,  nice  oak  trees 
around.   One  day  one  of  our  sanitarians  came  in  the  office  and 
announced,  "I've  been  up  there  looking  at  this  dam.   The 
squirrels  are  tunneling  in  it,  and  it's  going  to  go.   It's  an 
earthen  dam,  and  it  has  started  dripping  a  little  bit." 

Crawford:   Just  a  dam  of  sewage? 

Blum:      Yes,  of  sewage.   "Of  course,"  he  said,  "the  sprinkler  system  up 
there  isn't  working,  and  there's  much  more  sewage  than  they 


170 


thought  they  would  have  to  deal  with,  volumes  of  it  in  the  dam. 
It's  going  to  go.   I  don't  know  what  day  or  what  hour,  but  it's 
going  to  go."  And  while  he's  talking  it  goes.   It  floods  over 
the  Mt.  Diablo  Country  Club,  over  the  golf  course,  and  catches 
all  the  golfers  by  surprise. 

Crawford:   Is  this  raw  sewage  we're  talking  about? 

Blum:      Yes,  it's  raw,  just  that  it's  been  pumped  up  a  hill.   So  that 
was  the  end  of  that  sewage  system.   Before  it  went,  every  so 
often  we'd  go  look  at  it  because  the  invasion  pipes  would  be 
giving  out,  and  we  made  them  put  these  huge  patches  all  along 
the  invasion  pipe.   And  the  pump  doesn't  work  half  the  time. 
It  was  a  wild  mess  and  you  could  see  the  end  coming.   So  when 
it  went,  we  ended  up  putting  an  "unoccupiable"  sign  on  every 
single  house.   All  these  families  were  forced  out  of  their 
houses,  and  these  were  not  rich  people,  left  with  an  unusable 
house  and  payments  on  their  mortgage. 

Crawford:   Permanently? 

Blum:      Well,  until  something  could  be  done.   This  went  on  a  year  or 

two,  and  that  forced  the  issue  of  Contra  Costa  Central  Sanitary 
District  putting  in  a  sewer  all  the  way  past  Danville, 
essentially  to  San  Ramon. 

Crawford:   Did  the  sanitation  situation  eventually  work  out? 
Blum:      Yes,  eventually,  when  Central  San  took  the  job  on. 
Crawford:   That  must  have  been  very  uncomfortable  for  you  all  the  time. 

Blum:      It's  a  game,  all  the  time,  but  it  is  perfectly  legal.   However, 
the  state's  approval  of  that  horrible  system  was  unbelievable. 
Our  men  wouldn't  approve  it,  but  the  state  did.   Yet  I  doubt 
that  there  were  any  bribes  involved,  just  the  lure  of 
developing  California. 

Crawford:   Could  you  get  that  approved  today? 

Blum:      We  might.   I'm  sure  worse  things  are  approved  all  the  time,  but 
not  routinely. 


171 


Dealing  with  the  AEC  and  other  Federal  and  State  Watchdog 
Agencies  ## 


Blum:      A  most  alarming  situation  occurred  when  we  discovered  that  the 
AEC,  the  national  Atomic  Energy  Commission  whose  infamy  was 
highlighted  by  Tom  Lehrer's  little  ditties,  was  operant  in  our 
county.   They  had  taken  over  an  old  abandoned  cement  plant  and 
were  putting  radioactive  contaminated  wastes  in  secondhand  oil 
drums  with  plastic  liners.   Pieces  of  contaminated  equipment  as 
well  as  liquids  and  various  solids  were  mixed  in  with  cement 
and  water  and  allowed  to  solidify  in  the  oil  drums  which  were 
then  sealed.   The  drums  were  hauled  to  a  Sacramento  River  site 
adjacent  to  where  Antioch  was  obtaining  its  city  water.   They 
were  placed  on  tiltable  racks  on  a  small  ship,  taken  to  the 
Farallones  and  dumped  overboard  to  sink  to  the  ocean  bottom. 
This  was  a  brilliantly  conceived,  somewhat  less  than  long-term 
method  of  radioactive  contaminated  material  disposal. 

Our  inspectors  had  chanced  on  it  at  the  Antioch  waterfront, 
brought  along  a  Geiger  counter,  and  discovered  that  the 
secondhand  drums  were  leaking  radioactive  materials  at  the 
Antioch  water  intake  even  as  they  were  being  loaded  for  their 
burial  at  sea.   The  inspectors  took  the  boat  ride  to  the 
Farallones  and  discovered  that  not  all  barrels  sank,  some 
having  more  air  than  concrete.   The  AEC  remedy  was  simple:  they 
carried  a  rifle  and  shot  the  floating  barrels  to  let  out  the 
air  so  that  they  gurgled  and  sank—so  much  for  long-term 
entombment . 

Sounds  unbelievable,  but  it  was  worse.   When  I  got  on  the 
phone  to  the  local  AEC  operation,  they  made  it  clear  that  no 
stupid  local  health  officer  could  mess  around  in  their 
business,  and  would  I  please  shut  up  and  go  home.   My  response 
was  pretty  automatic:  padlock  the  cement  plant,  close  out  the 
loading  dock,  and  remove  the  ship  and  all  vestiges  of  the  river 
site  operation  by  morning.   If  we  found  any  evidence  of  AEC 
activity  remaining,  there  would  be  a  press  briefing  at  mid- 
morning  at  the  shipping  and  plant  sites  explaining  how  the  AEC 
was  exposing  the  users  of  Antioch  water  to  a  mindless 
radioactive  disposal  operation.   It  was  all  gone.   Years  later, 
I  met  the  physician  in  charge  whom  I  had  called  and  he  made  it 
clear  that  there  never  had  been  such  an  operation  as  the  one  I 
described.   Thus  one  built  trust  of  federal  agencies. 

A  similar  kind  of  event  occurred  around  a  grapefruit 
incident.   A  man  bought  Arizona  grapefruit  from  a  truck  in 
Lafayette,  drove  on  home  to  San  Jose,  started  to  eat  the 
grapefruit,  and  got  violently  ill.   The  Santa  Clara  County 


172 


Health  Department  was  called,  checked  it  out,  and  found  cyanide 
in  the  grapefruit.   Was  this  a  murder  attempt,  some  accident, 
or  something  to  do  with  the  life  of  a  grapefruit  this  day  and 
age?  They  called  us,  we  found  the  vendor,  bought  a  good  many 
sacks  of  fruit,  and  found  cyanide  inside  many  grapefruit. 

Quick  calls  to  the  state  health  department,  state 
agricultural  department,  the  USPHS,  and  the  U.S.  Department  of 
Agriculture  gave  us  no  information.   But  they  all  warned  us  not 
to  go  to  the  press  to  warn  people  of  the  danger  because  it 
would  be  bad  for  the  grapefruit  industry.   A  very  impressive 
concern  for  the  public's  health.   We  made  it  clear  that  we 
would  go  to  the  press  that  day  unless  the  whole  matter  was 
cleared  up. 

It  turned  out  that  Arizona  and  Texas  grapefruit  were  given 
a  cyanide  spray  at  the  California  border  for  some  irrelevant 
plant  pest  so  as  to  put  Arizona  and  Texas  grapefruit  at  an 
economic  or  cost  disadvantage.   If  the  sprayed  fruit  in  open 
trucks  got  into  a  rain,  the  cyanide  spray  would  be  dissolved 
and  would  go  through  the  skin  and  poison  the  meat  of  the 
grapefruit . 

That  border  control  process  discontinued  that  day. 


Anne  Leslie;  "Office  Wife' 


Crawford:   We  haven't  talked  about  your  staff. 

Blum:      At  the  very  heart  of  it  was  Anne  Leslie  —  she  was  my  office 
wife. 


Anne  was  a  very  pretty,  friendly  but  feisty  person,  about 
my  age--who  was  the  health  officer's  secretary  when  I  got 
there.   So  I  took  her  on  as  my  secretary,  and  was  I  ever  lucky. 
She  was  quite  diffident  about  herself  and  her  family,  only 
recently  did  I  learn  that  her  father  had  been  an  Oxford  don. 

She  was  very  defensive  of  me  and  used  to  describe  herself 
as  my  office  wife.   She  and  my  domestic  wife  formed  a  close 
team  as  they  became  good  friends  with  at  least  one  task  in 
common,  keeping  me  afloat. 

When  we  became  involved  in  vaccinating  everyone  in  the 
county  for  polio,  it  turned  out  that  my  long-planned  tour  of 
Europe's  health  programs  found  me  in  Finland  at  Mannerheim's 


173 


gravesite  on  the  Sunday  that  the  department  did  probably  50,000 
persons  by  taking  over  a  few  shopping  malls.   I  must  say  that  I 
enjoyed  that  day,  was  sure  our  people  would  cover  all  the 
bases,  and  they  did.   When  I  got  back  I  asked  Anne  if  she  had 
had  a  decent,  restful  time  of  it  while  1  was  gone,  no 
dictation,  no  arranging,  no  appointments,  no  grant  projects  to 
write  up.   In  her  charming  and  delightful  way  she  asked,  "Whom 
do  you  think  runs  the  department  and  makes  all  the  decisions 
while  you  are  gone?   Sure,  we  have  well-paid  assistant 
directors  in  charge,  but  what  do  they  do  when  you  aren't  here 
for  a  final  okay?   They  come  in  and  say,  'Anne,  what  would  the 
boss  have  done  about  this?'   That's  a  lot  of  responsibility." 
I  could  just  see  it  once  she  painted  the  picture.   Probably 
happens  in  lots  of  places. 

She  had  a  wonderful  trait  of  being  able  to  deliver  a  well- 
deserved  comeuppance  to  people  who  deserved  one.   As  soon  as  I 
became  health  officer  I  asked  for  a  half  day  off  per  week  with 
pay  for  me  and  for  any  of  my  assistants  who  wished  to  teach  or 
participate  in  university  courses.   I  taught  Friday  afternoons 
in  internal  medicine  at  Stanford  University  Medical  School  —  in 
many  ways  the  highlight  of  each  week.   One  Friday  Anne  called 
me  there  at  about  4:00  to  tell  me  that  she  had  had  a  most 
unpleasant  encounter  with  a  prominent  Richmond  attorney  who 
wanted  to  talk  to  me.   When  she  told  him  that  I  wasn't  in,  he 
wanted  to  know  where  the  health  officer  was  and  why  wasn't  he 
at  his  desk.   When  she  said  she  could  get  me  at  Stanford 
Medical  School  where  I  was  teaching,  he  became  even  more 
unpleasant  and  wanted  to  know  how  it  was  that  a  county  employee 
could  be  working  elsewhere  on  county  time. 

He  went  on  to  say  that  when  anyone  wanted  to  reach  him,  he 
was  always  at  his  desk.   This  had  been  too  much  for  my  Anne, 
and  she  came  back  ever  so  sweetly,  I'm  sure,  "My,  it's  too  bad 
that  you  have  such  a  poor  practice!"   This  concluded  their 
conversation  and  she  then  called  me,  fearing  that  she  may  have 
made  us  a  lifelong  enemy. 

When  I  called  him  back  the  following  Monday,  he  made  some 
remark  about  my  having  a  delightful  secretary.   A  few  months 
later,  he  called  her  to  see  if  she  would  come  to  work  for  him. 


The  Civil  Service  and  Other  Frustrations 


Crawford:   What  were  the  most  frustrating  things,  and  what  were  the 
biggest  accomplishments  in  Contra  Costa? 


174 


Blum:      Oh,  I  don't  know.   The  reason  I  probably  left,  ultimately,  was 
I  was  simply  getting  tired  of  recurring  hassles  such  as  those 
with  the  civil  service.   The  county  was  very  much  pro-labor, 
and  civil  service  was  strong.   You  couldn't  kick  employees 
around,  that  was  good,  but  the  civil  service  department  somehow 
got  the  notion  that  they  were  the  saviors  of  mankind.   Every 
time  the  health  department  had  a  job  to  fill,  they  would  decide 
what  kind  of  person  we  needed.   I  know  about  health  and  health 
care--but  they  would  come  over  with  the  specs,  and  say,  "Okay. 
You've  got  a  job.  Here's  what  we're  going  to  advertise  and  get 
for  you."   I  said,  "The  hell  you  are.   That's  not  what  we  need 
or  want.   It's  not  what  we  asked  for.   It's  not  what  was 
approved  for  us."   I  was  so  sick  of  it,  and  I  wasn't  the  only 
one.   George  Degnan  felt  the  same  way  because  of  the  county 
hospital's  needs.   But  I  hated  to  join  forces  with  him  because 
he  was  such  a  notorious  rule-breaker. 

So  I  stalled,  and  that  may  have  been  a  mistake  because  we 
could  have  gotten  rid  of  civil  service  at  the  time.   However, 
if  we  had  broken  the  civil  service  department,  then  we  would 
have  the  problem  of  getting  people  that  the  board  of 
supervisors  wanted  to  hire.   If  we  didn't  have  something  like  a 
merit  service,  the  board  of  supervisors  could  say,  "Well,  Mary 
Jones  would  be  good  for  that.   Why  don't  you  hire  Mary  Jones?" 
The  spoils  system  would  be  back. 

Crawford:   They  put  that  kind  of  pressure  on? 

Blum:      Well,  they  used  to  before  my  time,  but  that  was  all  gone  in  my 
day.   Civil  service  had  gotten  rid  of  it.   So  there  was  a  very 
strong,  good  side  to  the  civil  service.   They  ultimately 
brought  us  well-qualified  people,  by  and  large,  so  I  was  always 
reluctant  to  help  break  their  necks,  but  it  was  more  than  I 
could  stand  to  always  be  told  that  we  needed  the  wrong  kind  of 
people.   If  the  specs  were  wrong,  then  you  spent  six  months  or 
a  year  hassling  civil  service,  and  might  spend  more  time  before 
finally  getting  the  board  of  supervisors  to  tell  them,  "Okay, 
this  is  what  we  want."  Another  monotonous  event  every  year 
was,  "You  have  to  cut  the  budget."  Or  somebody  would  bring  in 
a  new  issue  which  was  in  fact  ancient.   I  had  a  drawer  of 
scenarios  that  was  kind  of  a  joke--when  you'd  get  one  of  the 
repeat  issues  you'd  say,  "Oh,  that's  started  again,"  you'd  pull 
out  the  drawer  and  you  get  the  folder,  and  say,  "This  is  the 
scenario  we  have  to  follow  to  handle  this  issue." 

Crawford:   Same  rigmarole? 

Blum:      Same  rigmarole  of  what  you're  going  to  have  to  fight,  except  it 
might  take  longer  this  time,  or  shorter,  whatever;  but  there's 


175 

a  point  at  which  you  get  tired  of  seeing  the  old  scenarios 
dusted  off,  although  they're  very  helpful. 

II 

Blum:      One  interesting  case  is  worth  recording.   One  of  the  more 

unpleasant  duties  of  a  CEO  is  demoting  or  firing  a  longtime 
employee  who  is  well  liked  but  less  than  useful.   As  I  began  my 
drop-in  inspections  of  restaurants,  I  discovered  that  the 
territory  of  one  of  the  inspectors  would  never  lead  anyone  to 
expect  the  presence  of  a  health  department  or  a  sanitary 
inspector.   I  went  through  all  his  functions  with  him  at  his 
next  review,  put  them  in  writing  in  his  folder.   The  next  year 
my  surprise  visits  found  no  improvement.   This  time  I  called 
him  in  and  demoted  him  to  a  lesser  rank. 

His  fellow  inspectors  and  their  supervisors  didn't  like 
this  ugly  new  phenomenon,  hired  a  lawyer,  and  asked  for  a 
hearing  at  the  Civil  Service  Commission.   Their  lawyer  was  a 
very  popular  fellow,  and  in  fact,  our  congressman  at  the  time, 
for  whom  I  had  voted,  no  less.   He  knew  me  well,  told  me  I 
didn't  have  a  chance  with  the  pro-labor  commission,  and  should 
rescind  my  action  before  the  hearing,  which  he  assured  me  would 
be  a  trial  about  me,  not  about  my  sanitarian.   I  told  him  that 
there  wasn't  going  to  be  any  turning  back,  that  the  demotion 
was  deserved,  and  if  lawyers  like  himself  were  inclined  to 
lessen  the  quality  of  county  services,  that  was  their 
prerogative. 

The  hearing  went  as  predicted  and  the  inspector  was 
reinstated.   However,  my  ratings  of  his  work  and  reasons  for 
them  were  made  a  matter  of  public  record,  and  I  looked  pretty 
good  in  a  situation  where  Tightness  was  irrelevant.   The  net 
result  was  very  good.   No  other  employee  wanted  a  night  in  the 
bright  lights,  so  what  1  put  in  their  ratings  became  very 
meaningful  from  then  on. 

A  few  years  later  when  I  was  at  the  university,  I  was  asked 
to  give  an  evening  lecture  on  aging  and  mental  health  in  Contra 
Costa.   There  were  about  400  people  in  attendance  and  who 
should  be  sitting  in  the  front  row  nodding  and  smiling  at  me 
but  this  same  sanitarian  and  his  wife,  who  was  also  a  health 
department  nurse.   When  it  was  all  over  they  clapped  and 
clapped,  and  came  up  to  tell  me  how  nice  it  was  to  see  me 
again.   That  was  the  nicest  part  of  the  evening. 

it 

Crawford:   So  those  were  some  of  the  frustrations? 


176 


Blum:      There  were  frustrations.   On  the  other  hand,  though,  as  you 

look  over  my  files,  you'll  see  the  number  of  papers  we  wrote, 
and  the  number  of  areas  we  worked  in;  it  was  fun.   We  had  a 
school  health  program  that  was  years  ahead  of  its  time—we  did 
some  work  on  genetics  counseling—that  was  twenty  years  ahead 
of  its  time. 

Crawford:   And  you  said  you  could  get  funding  easily? 

Blum:      Yes.   If  you  didn't  get  it  from  the  county,  you'd  get  grants. 
Everybody's  so  interested  in  what  you're  doing  that  you  can 
find  money  here  and  money  there— the  TB  Association,  the  Heart 
Association,  the  Mental  Health  Association. 


More  about  the  Mental  Health  Program,  and  Serving  with  the 
Space  Cadets:  1956-1965 


Crawford:   How  would  your  county  have  stacked  up  with  San  Francisco  in 
mental  health,  at  that  point?  Or  another  county? 

Blum:      Well,  it  was  just  backwoods  [in  the  beginning].   There  were  no 
services.   San  Francisco  had  a  million  agencies  to  do 
everything,  and  still  does.   It  doesn't  mean  they  do  well;  they 
often  do  badly,  but  at  least  it  had  those  things.   Instead  of 
talking  about  setting  up  an  agency  to  do  psychiatric  help,  we 
said,  "Well,  let's  have  the  teachers  do  a  better  job;  let's 
have  the  cops  do  a  better  job,"  the  nurses,  the  social  workers, 
and  so  on.   It  was  a  big  thing,  but,  in  turn,  it  led  to  the 
demand  for  more  specializing.   The  psychiatrists  worked  as 
consultants  in  the  program.   That's  how  they  got  their  foot  in 
the  door,  and  they  could  make  a  living.   They'd  be  hired  for  so 
many  hours  a  day  to  work  with  the  school  teachers  or  with  the 
nurses  or  with  the  police,  or  whatever.   It  was  a  big  program. 

It  was  kind  of  fun,  and  it  resulted,  ultimately,  thanks  in 
good  part  to  Leonard  Duhl,  that  I  worked  with  the  National 
Institute  of  Mental  Health  for  years.   I  was  on  several  of 
their  committees  awarding  grants,  studying  various  issues. 

Crawford:   While  you  were  in  Contra  Costa? 

Blum:      In  Contra  Costa,  yes.   It  really  started  with  Len  Duhl  and 

something  he  called  the  Space  Cadets.   He  convened  a  committee 
for  NIMH,  "Social  and  Physical  Environment  Variables  as 
Determinants  of  Mental  Health"— pretty  wild.   Len  called  the 
committee  the  "Space  Cadets."  He  was  the  first  health  planner 


177 


Crawford : 
Blum: 


in  the  National  Institute  of  Mental  Health,  although  they 
didn't  call  him  a  planner,  but  that's  what  he  was. 

He  and  I  had  spent  a  lot  of  time  wandering  around  the 
county,  studying  all  these  issues  of  sewage  and  health  and 
schools—you  name  it—during  his  two  years  with  us.   He  and  I 
were  very  well  aware  of  the  fact  that  important  issues  are  not 
going  to  be  solved  by  any  one  discipline.   There  was  no  way; 
the  issues  are  much  too  broad,  involved  all  kinds  of  people. 

So  in  1956  he  had  created  the  Space  Cadets,  made  up  of 
people  from  every  major  discipline—the  famous  lay  worker  Alice 
Day  from  the  Catholic  church;  Doxiodes,  the  world-famous 
planner  from  Greece.   He  had  this  man  Miller,  who  founded  the 
general  systems  theory  in  this  country,  from  the  University  of 
Chicago;  he  had  an  astrophysicist  from  Chicago,  Rashevsky.   He 
had  some  wonderful  sociologists  and  anthropologists— Sandy 
Hollingshead  from  Yale.   Then  he  had  Sir  Jeffrey  Vickers  from 
England,  and  the  head  sister  from  Webster  College,  Jacqueline. 
She  left  the  order,  ultimately,  and  became  the  president  of 
City  College  of  New  York,  and  married  a  Jewish  banker.   She  was 
something  else;  she  was  fantastic.   Mel  Weber  from  Berkeley, 
and  before  Mel  Weber,  Catherine  Bauer,  who  was  Mrs.  William 
Wurster— a  famous  planner,  housing  expert,  in  her  own  right. 

So  there  were  all  these  and  many  more  interestingly  placed 
people  from  different  parts  of  the  world.   We  met  for  three 
days  at  a  time  three  or  four  times  a  year,  usually  in  D.C. 

In  Washington? 

Usually,  not  always.   Duhl  was  putting  these  people  together 
and,  for  at  least  the  first  year,  every  one  of  these  people 
would  spend  a  half  a  day  describing  to  the  group  what  he  or  she 
was  doing  or  what  they  felt  they  were  doing,  and  then  everybody 
else  would  chew  on  it.   It  turned  out  we  didn't  understand  one 
another's  work,  not  even  their  vocabularies.   It  was  a  very 
interesting  learning  experience. 

All  these  people— many  of  them  world- famous --really  didn't 
understand  what  the  others  were  doing.   John  Seeley,  the 
Canadian  sociologist,  was  there,  and  it  fell  to  him  to  sum  up 
briefly  what  each  person  seemed  to  be  doing.   Usually,  the 
people  who  had  been  the  subject  for  the  day  wrote  down 
everything  he  said,  because  it  was  usually  a  lot  clearer  than 
what  they  had  just  told  us.   It  was  a  fantastic  experience  for 
me,  a  country  hick,  you  know.   Also  from  Berkeley,  there  was 
Alex  Meikle John- -the  world-famous  educator  and  expert  on 


178 


constitutional  law,  and,  ultimately,  Scott  Buchanon  from 
Annapolis --St.  John's  Academy. 

Crawford:   All  these  people  were  on  the  committee? 

Blum:      The  committee,  yes.   That  is  what  I  was  exposed  to,  and  these 
people  had  all,  more  or  less,  been  involved  in  academia,  and  I 
had  not.   They  were  used  to  philosophizing  on  the  world's  major 
issues,  but  not  even  they  were  aware  of  the  confusion  and 
relationships  between  the  outlooks  of  the  various  disciplines, 
particularly  when  the  group  focused  on  clarifying  an  issue  or  a 
societal  need. 

Crawford:   What  years  were  these? 

Blum:      We  started  out  in  1956,  and  it  ran  until  '65--a  tremendous 
time.   In  1956  I  received  this  letter  from  Len  Duhl  saying, 
"We'd  like  you  to  be  a  member  of  the  Space  Cadets,"  so  I  went 
to  the  board  of  supervisors  with  the  letter,  and  when  you  go 
before  the  board  this  is  public  information- -and  here  we  go, 
Space  Cadets.   Well,  I  was  Buck  Rogers.   All  the  newspaper 
reporters  were  there,  and  the  board  was  sort  of  looking  at  me 
and  smirking  like,  "Good  Lord,  this  health  officer  hasn't  got 
an  ounce  of  brains,  coming  with  a  request  like  that."   I  wasn't 
asking  for  money,  I  was  asking  permission  to  be  gone  for  three 
days . 

The  chairman  of  the  board,  an  attorney  from  Concord,  said, 
"Well,  I  don't  think  we're  paying  the  doctor  so  that  he  can  go 
to  Washington  to  join  the  Space  Cadets."   If  you  were  an 
officer  of  the  county,  you  couldn't  leave  the  county  because  of 
an  old  California  law  that  said  you  had  to  get  permission  from 
the  board  to  do  so.   There  had  been  a  long  history  of  officers 
leaving  with  whatever  cash  was  lying  around  in  their 
department . 

II 


Blum:  This  was  the  first  time  I'd  ever  really  asked  for  permission  to 
do  anything,  so  the  next  board  member  gave  his  little  spiel  and 
another  and  another  member  then  said  that  it  was  ridiculous. 

Finally,  there  was  a  new  member  of  the  board,  Joe  Silva, 
about  whom  I  shall  elaborate—a  wonderful  man,  a  great  big  man 
--who  called  himself  a  "black  Portuguese."  This  was  typically 
his  warning  to  stupid  people  to  not  throw  around  racial 
epithets.   The  chairman  said,  "Well,  Joe,  what  do  you  think?" 
So  Joe  sort  of  sat  back,  and  rocked  in  the  fancy  board  chair, 
and  he  said,  "Well,  you  know,  I  used  to  be  the  mayor  of 


179 


Brentwood"--it 's  a  little  city  in  Contra  Costa--and  he  said, 
"One  year  I  thought  I  ought  to  go  to  the  meeting  of  the 
California  mayors,  but  the  city  council  never  would  let  our 
mayor  go  to  meetings.   They  didn't  want  to  waste  the  money  on 
them,  so  I  paid  my  own  way,  and  what  do  you  suppose  I  found? 
We  weren't  even  getting  our  share  of  the  sales  taxes.  We  had 
never  put  in  a  request  for  our  share  of  the  money.   Mr. 
Chairman,  I  move  that  the  doctor  go  to  Washington." 

One,  two,  three,  four,  five  yes  votes  and  I'm  off  to 
Washington.   This  man  used  to  run  a  roadhouse,  and  he  became 
the  mayor  of  Brentwood;  he  was  this  and  that  and  had  been  a 
judge.   He  used  to  say  he'd  never  been  to  school.   He  might 
have  been  right.   Other  people  said  he'd  been  a  football  player 
at  Oklahoma  in  their  great  days.   I  never  did  know,  really, 
where  Joe  stood  educationally. 

Then  it  came  up  budget  time.   I  remember  I  had  to  appear 
before  a  little  subcommittee—a  couple  of  board  members  —  and  it 
was  after  lunch,  about  two  o'clock.   Joe  was  a  big  eater,  big 
drinker.   I  don't  mean  a  drunk,  but  he  would  have  several 
drinks  at  lunch,  and  eat  big  meals  and  so  on.   So  this  was 
right  after  lunch  and  he  just  dozed  off.   The  other  man,  who 
was  a  real  wisenheimer--a  lawyer  and  a  board  member—was  taking 
apart  our  budget,  and  you  sort  of  give  ground  because  you  have 
to.   If  they  don't  get  to  cut  your  budget,  well,  then  they  feel 
badly  about  themselves  irrespective  of  whether  it  may  or  may 
not  be  destructive  or  helpful  to  your  department  or  the  people 
of  the  county. 

So  he  was  pleased  with  himself,  he'd  screwed  up  a  half  a 
dozen  things,  and  he  shook  Joe's  shoulder,  and  he  said,  "Joe, 
how  do  you  feel  about  this  budget?"  Joe  sort  of  shook  his 
head,  woke  up,  and  said,  "Tom,  you  know  how  I  feel  about  your 
messing  around  with  this  budget.   We're  gonna  buy  a  truck,  but 
we're  not  gonna  have  the  guy  to  drive  it.   If  we're  going  to 
buy  a  typewriter,  we're  not  going  to  have  the  secretary  to  type 
on  it.   We're  going  to  do  some  other  damn  fool  thing.   That's 
what  you  always  do  with  these  budgets,"  and  he  went  back  to 
sleep.   Our  budget  was  put  to  rights  at  this  point. 

Joe  was  a  real  philosopher  from  the  sticks--!  always 
appreciated  Joe.   In  recent  times,  he's  made  headlines.   He's 
been  dead  for  some  years.   Recently  it  was  ex-Mayor  Christopher 
from  San  Francisco  who  took  the  credit  for  having  gotten  Joe 
Silva  to  vote  for  BART. 

For  BART  to  succeed,  to  go  into  business,  it  had  to  have 
three  counties  of  the  five  Bay  Area  counties,  and  in  each  of 


180 


the  three  counties,  of  course,  at  least  three  members  of  the 
board  of  supervisors  had  to  vote  for  it  —  three  out  of  five. 
Alameda  and  San  Francisco,  naturally,  voted  for  it,  and  Contra 
Costa  was  the  only  one  left  at  that  time.   San  Mateo  wouldn't 
do  it. 

Crawford:   Marin  didn't. 

Blum:      Marin  didn't.   Contra  Costa  was  potentially  for  it.   That 

afternoon,  I  was  presenting  something  or  other  to  the  board  of 
supervisors.   Then  they  had  an  adjournment  in  the  middle  of  the 
afternoon,  and  I  went  into  the  little  board  room.   Joe  was  in 
there,  and  I  was  there  with  another  man  who  ultimately  became  a 
professor  here. 

Joe  started  soliloquizing.   He  said,  "Now,  this  BART  thing 
is  coming  up  this  afternoon,"  and  he  said,  "it  isn't  going  far 
up  into  the  county,  and  everybody  up  there  is  against  it 
because  they'll  never  see  BART  in  their  lifetime,  and  I  won't 
see  it  in  my  lifetime.   So,"  he  said,  "we're  split  two  and 
two."  Two  supervisors  at  the  west  end  of  the  county  are  for 
it,  two  on  the  other  end  are  against  it.   And  Joe  is  way  out 
there  —  at  the  far  end  of  the  county,  the  Brentwood  end.   He 
said,  "I've  got  to  decide  what  to  do." 

So  for  half  an  hour,  I  listened  to  him  figure  out  what  to 
do.   It  was  just  magnificent.   He  thought  of  his  brother-in- 
law,  who  had  an  orchard.   He  said,  "Now  what '11  this  do  to  him? 
Well,  the  taxes  will  be  about  this  and  this,  and  if  it's  as 
good  as  everybody  says  it  is  for  the  development  of  Contra 
Costa,  he'll  get  those  advantages." 

Crawford:   So,  very  practical,  pragmatic? 

Blum:      Fabulous.   He  thought  of  farm  owners,  he  thought  of  school 

teachers,  he  thought  of  businessmen.   He  said,  "I  can't  see  how 
it  would  do  any  damage  to  any  of  them.   The  only  person  being 
damaged  would  be  me  because  they'll  vote  against  me- -they '11 
get  mad—because  BART  is  so  far  away.   Well,  I'll  vote  for  it." 
And  we  had  BART.   This  is  the  same  Joe  Silva  that  sent  me  to 
Washington.   It  really  changed  my  whole  life,  too. 


181 
Being  Considered  for  a  Faculty  Position  at  Harvard 


Blum:      In  1959,  as  our  mental  health  work  went  sailing  along,  and  as 
we  published  a  paper  on  its  thrust,1  I  was  asked  by  Dr.  Erich 
Lindeman,  Harvard's  chief  of  psychiatry,  to  consider  joining 
his  faculty  in  a  community  and  administratively  oriented  mental 
health  position. 

I  had  met  Erich  in  1949  when  I  took  my  M.P.H.  at  Harvard 
and  attended  his  class  in  community  mental  health.   Erich  had  a 
miserable  squeaky  voice,  especially  for  a  plump,  cherubic,  mid 
sized  man  of  fifty-five.   I  had  assumed  he  was  going  to  be  our 
worst  lecturer.   His  course  took  place  in  one  of  the  ancient 
amphitheaters  of  Mass  General  Hospital  (MGH)  such  as  ether 
anesthesia  had  been  demonstrated  in.   Our  huge  class  of  about 
100  was  stacked  from  the  central  hole  or  working  space  up  to 
the  rafters.   Our  first  session  was  a  demonstration  of  a 
psychiatric  therapeutic  intervention.   Erich  was  down  in  the 
hole  with  just  the  young  woman  patient  whom  he  was  reassuring 
in  his  squeaky  voice  that  all  the  people  above  were  his 
friends;  and  that  she  could  relax  as  he  and  she  went  about  her 
therapy  session.   Erich  was  a  magician,  she  relaxed,  and  we  all 
became  intent  as  we  heard  a  magnificent  therapeutic  exchange. 
Erich  was  promptly  our  favorite  professor,  whose  presentations 
we  never  missed. 

When  I  received  the  offer  to  come  to  Boston,  it  seemed 
unlikely  that  we  would  ever  want  to  leave  the  Bay  Area  again, 
as  much  as  we  had  loved  the  Boston  area  a  decade  previously. 
Our  four  years  away  from  home  had  pretty  well  confirmed  our 
addiction  to  the  Bay  Area  where  both  of  us  had  been  born  and 
grew  up.   But  Harvard  was  Harvard,  and  we  decided  to  give  it  a 
try.   We  got  an  agreement  to  spend  the  month  of  September  there 
and  make  up  our  minds  on  the  job,  so  to  speak.   I  received 
travel  and  living  expenses  and  the  equivalent  of  a  month's 
respectable  professor's  salary.   We  took  leave  from  Contra 
Costa  and  went  via  Canada  with  our  bicycles  anchored  on  the 
back  of  our  station  wagon. 

Boston  was  socked  in  every  day  we  were  there,  no  leaves 
that  year.   Our  motel  was  adequate,  but  didn't  add  much  to  the 
ambiance.   Some  of  my  former  students  tried  to  cheer  us  up,  but 
that  wasn't  an  unmitigated  success.   Visiting  the  Glimchers,  in 


'Blum,  H.L.,  and  W.A.  Ketterer.   "A  Health  Department's  Activities  in 
Mental  Health."   Public  Health  Reports  78:7,  619-626,  July  1958. 


182 


whose  home  we  had  lived  ten  years  before,  was  the  one 
restorative  and  we  had  some  fun  times,  including  reminiscences. 

The  work  with  Erich  was  exciting  and  more.   He  asked  me  to 
begin  with  a  full  review  of  all  aspects  of  his  department, 
which  included  a  tiny  community  center  based  at  Wellesley,  the 
McLean  Hospital  outside  Boston,  and  his  immediate  department  at 
Massachusetts  General  Hospital  (MGH) .   I  soon  discovered  that 
Erich  had  a  significant  inferiority  complex  and  wanted  me,  an 
administrator,  to  overcome  all  his  imagined  inadequacies  as  an 
administrative  head  of  a  huge  empire.   It  reminded  me  that  in 
Contra  Costa  our  department  had  always  used  an  outside 
psychiatrist  to  keep  us  level-headed  and  honest,  sort  of  a 
magical  amulet.   In  Boston,  Erich  felt  that  an  administrator 
was  to  do  the  same  thing  for  a  group  of  mental  health 
academics,  whose  department  he  felt  was  not  functioning 
adequately,  even  though  it  was  probably  the  best  one  in  the 
U.S. 

I  started  visiting  the  overall  administrative  entities  at 
MGH  in  which  we  were  embedded.   No  one  seemed  depressed  about 
Erich's  performance  except  Erich. 

I  learned  a  bit  for  myself  when  I  interviewed  the 
administrative  head  of  the  private  wing  of  the  hospital.   He 
had  a  longstanding  problem  of  persuading  his  personnel  that 
they  were  being  fairly  treated  if  they  were  not  graduates  of 
the  MGH  programs.   He  had  invited  in  the  Boston  Globe  and 
ingeniously  given  an  interview  about  the  background,  origins, 
and  training  of  all  of  his  department  heads.   It  so  happened 
that  very  few  had  trained  at  MGH.   As  I  interviewed  him,  he  was 
suffering  from  a  barrage  of  complaints  about  how  no  one  who  was 
trained  at  MGH  had  a  chance  to  get  ahead,  overkill  in  spite  of 
his  deft  public  exposure  of  the  realities. 

In  Erich's  own  unit  I  soon  gained  the  confidence  of  his 
administrative  people  and  was  promptly  urged  to  avoid  letting 
Erich  buy  any  more  recording  devices—they  had  a  closet  full  of 
them.   It  seems  that  his  lectures  and  public  addresses  were 
typically  a  wild  success  and  he  wanted  to  capture  them—hence 
the  recorders.   What  he  overlooked  was  that  he  read  any 
audience  like  a  book  and  what  he  gave  them  was  so  astutely  on 
the  mark  that  he  was  indeed  always  enthusiastically  received. 
When  such  a  talk  was  transcribed,  there  was  no  such  audience 
and  the  magic  the  talk  had  evoked  was  irrelevant  to  a 
subsequent  audience.   This  led  to  a  never  ending  search  for 
better  recording  devices. 


183 


Erich  had  been  carefully  excluded  by  the  Harvard  Divinity 
School  from  addressing  its  graduate  students,  apparently  out  of 
fear  that  he  would  draw  the  best  into  the  fold  of  psychiatric 
counseling,  a  subject  which  was,  of  course,  central  to  their 
own  divinity  careers.   As  I  arrived  there,  he  had  broken 
through  that  taboo  and  was  giving  his  first  major  address  to 
the  divinity  school  classes.   Prior  to  that  their  students  had 
to  find  time  to  join  Erich's  classes  as  best  they  could.   He 
had  me  go  along,  and  for  sure,  it  was  another  wild  success  and 
probably  did  result  in  the  feared  student  defections.   It  was 
all  too  clear  that  the  lecture  by  itself  without  the  presence 
of  its  intended  audience  wasn't  going  to  be  nearly  as  exciting. 
We  got  that  point  across  subsequently. 

Mrs.  Lindeman,  who  was  an  outstanding  psychiatric  social 
worker,  regarded  me  as  an  anathema  because  she  saw  that  Erich 
might  be  bamboozled  into  letting  an  administrator  take  control. 
However,  at  the  end  of  three  weeks  I  told  him  that  there  was  no 
likelihood  that  I  would  ever  live  happily  in  Boston,  much  as  I 
would  like  to  be  with  him  at  Harvard.   We  set  aside  a  full  day 
for  a  recounting  and  discussion  of  my  observations.   On  that 
day  he  invited  me  into  his  inner  office  and  offered  me  the 
reclining  chair  next  to  his  desk.   I  declined,  telling  him  that 
roles  were  reversed,  that  he  was  the  client  and  I  was  the 
therapist.   He  was  a  good  sport  and  took  the  recliner. 

I  began  on  my  list  of  observations.   He  was  bitterly 
unhappy  that  few  of  his  division  chiefs  came  to  his  weekly 
staff  meetings  on  time  and  many  hardly  ever  came.   I  pointed 
out  that  when  he  had  been  brought  to  Harvard  a  few  years 
previously,  he  had  been  directed  to  create  the  finest 
department  extant.   In  turn,  he  had  recruited  each  of  his 
division  chiefs  as  the  keenest  person  in  their  area  and  each 
was  told  that  all  that  was  expected  of  them  was  being  the  best 
in  their  field,  and  keeping  Harvard  number  one.   None  had  ever 
been  told  that  Erich  meant  to  supervise  them  or  have  them 
participate  in  staff  meetings.   He  had  sought  out  potential 
prima  donnas .   Did  he  want  to  change  them  now  that  he  had  them? 
I  indicated  that  if  I  were  the  boss  and  wanted  these  associates 
to  toe  the  line  and  come  to  staff  meetings,  they  would,  or  they 
wouldn't  be  there  very  long.  So  did  he  really  want  them  to 
show,  given  that  each  was  bringing  fame  to  Harvard,  as  was  he, 
and  if  they  didn't,  would  he  really  pursue  their  replacement 
insofar  as  the  Harvard  structure  would  allow?  He  seemed  to  say 
that  yes,  he  would  demand  their  cooperation.   I  couldn't  let 
this  show  of  bravado  go  as  Erich  wouldn't  push  a  cat  out  of  his 
way.   So  I  said,  "Would  you  really  let  someone  go?"  He  slowly 
allowed  that  he'd  have  lots  of  trouble  even  talking  about  it, 


184 


and  I  suggested  that  he  live  within  his  own  capabilities  and 
stop  torturing  himself. 

I  tried  to  leave  him  with  my  belief  that  he  was 
administering  in  a  way  that  was  right  for  him  and  that  the 
proof  of  the  pudding  was  the  quality  of  the  department, 
discipline  or  no. 

The  next  day,  my  last  one,  I  got  a  call  from  Mrs.  Lindeman, 
who  was  gasping  with  an  upper  respiratory  problem,  apologizing 
profusely  that  she  couldn't  send  me  off  appropriately,  that  she 
had  come  to  appreciate  my  help  for  Erich,  that  I  really  wasn't 
the  threat  she  had  feared  originally.   So  we  left  happily  and 
never  regretted  what  was  a  good  time  after  all,  reunion  with 
our  friends  the  Glimchers,  and  a  chance  to  bicycle  in  some  of 
the  eastern  Canadian  provinces  as  well. 


Co-Authoring  a  Book  about  Administration;  1963;  A  Housing 
Project  in  East  St.  Louis;  Lincoln  Hospital  in  New  York  ## 


Crawford:   That  was  your  first  consulting  then,  wasn't  it? 

Blum:      First  big-time,  yes.   Not  really  consulting,  just  participating 
at  this  level. 

As  another  benefit  from  working  on  the  Space  Cadets,  I  got 
acquainted  with  Alex  Meiklejohn  and  commenced  to  understand 
what  our  constitution  was  about.   I  came  home,  and  I  said, 
"I've  got  to  learn  about  and  then  write  a  book  on 
administration  because  what  we're  doing  is  a  joke;  it's  a 
travesty,  and  the  books  I've  studied  are  irrelevant.   We're 
paying  no  attention  to  the  history  of  this  country  or  to  our 
political  and  cultural  heritage  in  the  course  of  administering 
a  county  agency.   As  an  administrative  agency  of  government,  we 
ought  to  be  in  line  with  our  people  and  our  country." 

It  led  me  to  write  a  book  that  was  way  ahead  of  its  time- 
twenty-five  years  ahead  of  its  time.1  All  the  traditional  rules 
of  administration  that  I'd  been  taught  were  garbage.   That's 
the  reason  the  teachings  on  administration  changed  every  five 
to  ten  years--a  whole  new  look.   There  were  a  whole  set  of 
interests  that  had  been  left  out  at  one  time,  then  another  set 


'Blum,  H.L.,  and  A.L.  Leonard,  Public  Administration;  A  Public  Health 
Viewpoint.   The  Macmillan  Co.,  1963. 


185 


of  interests  at  the  next  look,  and  so  on.   The  book  was  devoted 
to  looking  at  all  the  interests  that  have  to  be  relevant  to  a 
health  department.   Its  own  doctors  are  one  group,  its  own 
nurses  are  another.   Nurses  typically  were  the  first 
professionals  in  their  family;  they  don't  see  the  world  like 
doctors  do. 

Crawford:   You  have  a  lot  of  respect  for  nurses. 

Blum:      Oh,  yes.  They  did  the  real  work  for  the  health  department, 

there  was  no  question.   That  was  where  it  was  at.   That  was  a 
strong  nursing  group  in  Contra  Costa;  the  guts  of  the 
department. 

Then,  as  you  look  at  other  people  in  the  department,  you 
realize  their  backgrounds  are  very  different.   But  more 
importantly,  when  you  look  at  the  consumers  that  you're  dealing 
with,  there  are  all  kinds  of  them  ranging  from  Orinda  and 
Moraga  to  far  into  Pittsburg,  or  enclaves  that  don't  even  know 
English.   So  your  clients  are  all  different;  you  can't  pursue 
the  same  approaches  with  all  of  them.   This  is  what  America  is 
really  all  about,  or  should  be. 

So  I  found  another  health  officer  by  the  name  of  Al  Leonard 
who  thought  like  I  did—the  only  thing  wrong  with  our  writing  a 
book  together  was  that  we  agreed  on  almost  everything.   The 
book  was  released  by  Macmillan  in  1963,  and  that  book  opened 
the  door  for  me  to  become  a  professor.   The  book  was  pretty 
eloquent  thinking  for  me.   All  the  other  things  I  had  done  were 
clearly  diverse--!  was  not  specializing  in  anything;  I  worked 
on  one  thing,  went  on  to  the  next,  and  the  next,  and  the  next. 
But  the  diversity  of  issues  and  the  diversity  of  the  people  or 
interests  involved  got  me  thinking,  and  this  book  wrapped  it 
all  up  with  the  message  that  administration  had  to  be  built 
around  taking  differences  into  account.   It  was  a  systems  view 
before  I  understood  what  systems  thinking  was  all  about. 

At  that  committee  of  Space  Cadets  we  did  a  lot  of  fun 
things- -we  explored.   I  ended  up  visiting  East  St.  Louis  long 
before  its  housing  was  blown  up,  before  it  had  become  known  for 
the  jungle  it  was.   The  government  built  all  this  wonderful 
housing  and  then  blew  it  up  in  recent  years.   It  was 
intolerable,  a  ghetto  that  was  a  dozen  stories  high  and  solid 
with  trouble. 

I  was  a  consultant  for  a  lot  of  issues--!  got  on  other 
committees  as  a  result  of  that  one.   Some  of  them  were  granting 
funds  for  mental  health  projects.   I  made  the  field  visit  to 
Lincoln  Hospital  in  New  York  for  National  Institute  of  Mental 


186 


Crawford: 
Blum: 


Crawford: 
Blum: 


Health  (NIMH) --the  one  that  became  so  famous  because  the 
workers  took  it  over.   My  wife  was  accompanying  me,  and  when  we 
got  there  for  the  NIMH  annual  visit  for  renewing  the  grant,  the 
workers  had  taken  over  the  whole  place  that  morning.   It  was  a 
far-out,  fantastic  situation.   We  got  there  early,  and  we  were 
welcomed  by  some  of  the  workers  who  had  taken  over. 

In  anticipation  of  your  coming? 

It's  possible,  but  we  never  heard  that.   I  think  the  takeover 
was  in  the  wind  for  a  long  time.   We  got  into  a  little  old 
Volkswagen,  and  a  black  man--a  big,  heavy-set  guy--started 
taking  us  around,  showing  us  the  community  and  all  the  various 
little  extra  clinics  and  things  that  related  to  Lincoln 
Hospital.   Books  have  been  written  about  it;  Fitzhugh  Mullen 
wrote  a  book  about  it.   He  is  an  important  figure  in  the 


Clinton  administration  somewhere, 
physician. 


He's  a  fine  person,  also  a 


In  any  event,  it  was  a  pretty  tense  day,  and  so  we  were 
kept  away  from  the  hospital  for  about  the  first  half  day,  and 
instead  looked  at  all  the  little  ancillary  things  they  were 
doing.   I  remember  this  man  showing  us  a  Puerto  Rican  grocery 
store  on  a  corner,  just  across  from  a  city  park—this  was  South 
Bronx  country—and  saying,  "That  man  is  a  dope  dealer.   He's 
killed  so  many  of  our  people."  He  said,  "He  has  to  stop 
selling  drugs.   We're  not  going  to  put  up  with  it  anymore. 
There  he  is  out  there  in  the  park  with  his  little  ice  cream 
wagon,  and  he's  peddling  dope.   He's  been  warned."   He  said, 
"We'll  bring  boys  in  from  across  town,  and  he  will  be  gone." 
And  he  was;  he  was  killed  shortly  thereafter. 

Really? 

Oh,  yes.   They  were  playing  for  keeps.   This  was  a  community 
saying,  "We  just  can't  tolerate  these  parasites  who  are 
destroying  our  kids  and  our  families."  And  this  is  a  mental 
health  clinic! 

Then  we  went  here,  we  went  there,  and  finally  came  back  to 
the  headquarters,  and  things  were  cooling  down,  and  people  were 
taking  on  duties.  Some  of  the  docs  were  there. 

In  any  event,  at  the  end  of  the  day,  they  let  the  director 
of  the  clinic  in  so  I  could  see  him.   The  director  of  the 
clinic  was  a  famous  psychiatrist;  I'm  trying  to  think  of  his 
name.   He  went  to  UCLA  from  New  York,  as  I  recollect.   I  knew 
this  man  because  we  were  on  many  of  the  same  committees  in 
Washington,  D.C.   So  I  reminded  him,  "You  know,  when  you  sold 


187 


us  on  this  project,  you  presented  what  you  wanted  to  do  here, 
and  one  of  the  things  you  told  us  was  that  if  this  were  really 
a  success,  they'd  kick  your  ass  out  of  here  at  the  end  of  the 
year."   I  said,  "Do  you  know  what?  This  is  a  year,  today."   I 
said,  [laughter]  "Get  your  ass  out  of  here.   You're  a  success." 

Crawford:   That's  a  really  charitable  evaluation,  I  would  say. 

Blum:      He  was  really  furious.   He  wasn't  the  least  bit  happy,  but  the 
truth  of  the  matter  is  that  there  was  some  virtue  to  his 
prognostication,  and  to  the  fact  that  it  could  happen,  and  that 
people  could  run  it  without  him  for  a  day  or  two.   In  any 
event ,  I  think  we  ended  up  giving  them  the  money  again  for  the 
next  year,  and  the  lesser  staff  and  the  patients  earned  the 
right  to  a  lot  more  say  in  the  operation. 

Crawford:   That's  great.   Did  you  write  about  that? 


Funding  for  Navajo  Projects 


Blum:      No,  I  didn't.   That  was  just  part  of  the  job.   Then  I  remember 
we  went  to  see  the  Navajos,  who  were  asking  us  to  train  a  few 
medicine  men.   We  gave  them  the  money  for  training  medicine 
men,  which  lasted  for  quite  a  few  years;  because  the 
practitioners  were  dying  out,  they  were  disappearing.   What  was 
clearly  evident  when  you  visited  them  was  that  there  were 
Indians  who  wouldn't,  for  example,  take  treatment  for  TB 
without  the  intervention  of  the  medicine  man,  and  the 
physicians  might  not  get  to  treat  a  tubercular  patient  without 
the  family  participation  that  the  medicine  man  brought  to  the 
relationship. 

Crawford:   Was  that  controversial? 

Blum:      Well,  sure,  very;  but  I  had  a  wonderful  couple  of  committees 
that  I  was  on  because  I  was  free-wheeling  and  didn't  know  all 
the  rules.   It  looked  like  a  good  idea,  and  when  we  talked  to 
the  Anglo  doctors  out  there,  we  could  see  why  they  wanted  it. 
It  wasn't  just  a  notion  of  the  Navajos;  so  many  of  them  can't 
receive  our  therapy  until  they're  all  quieted  down,  and,  of 
course,  much  of  the  medicine  man's  routine  is  reconciling 
people  with  their  families.   People  don't  appreciate  that,  but 
they  bring  families  together. 

People  whose  families  are  split  apart,  and  people  who  are 
very  disturbed,  are  all  brought  together  with  a  ceremony  for  a 


188 


day  or  a  week  or  a  couple  of  weeks.  When  the  ceremony  is  over, 
they're  kind  of  all  together  again,  and  now  the  sick  person  can 
go  on  with  his  or  her  life,  or  with  Western  medical  care. 

I  remember  going  up  to  this  big  mental  hospital  near  the 
airport  between  Tacoma  and  Seattle  and  making  the  site  visit; 
we  turned  over  big  grants  to  those  people.   Ex-patients  were 
starting  to  do  therapy  on  the  new  patients.   It  was  kind  of 
like  that  San  Pablo  thing—if  you  got  people  who  could  relate 
to  others  in  trouble  because  of  experiences  in  common  and  could 
use  information  positively,  it  was  possible  to  reach  people  you 
otherwise  couldn't  reach. 

So  that  was  an  interesting  use  of  ex-patients,  and  it  was 
good  for  them,  of  course.   Alcoholics  Anonymous,  in  many  ways, 
is  doing  that.   They're  keeping  themselves  well  by  helping 
others.   It  was  not  all  that  different.   There  were  things  that 
were  similar,  and  we  were  the  NIMH  committee  that  made  those 
decisions.   I  did  that  for  quite  a  few  years  for  NIMH.   That 
all  started  with  Len  Duhl  and  his  creation,  the  Space  Cadets. 
And  that  is  how  I  became  an  academician. 


The  Multipurpose  Worker  and  the  Rodeo  Center:  1964 


Crawford:   Well,  we  didn't  talk  about  that  multipurpose  worker  yet.   Do 
you  want  to  talk  about  your  research  in  that  area? 

Blum:      Well,  that  was  a  dream,  also,  because  part  of  the  thinking 
about  how  you  could  help  people  who  were  unhealthy  had 
something  to  do  with  how  you  could  reach  them,  and  something  to 
do  with  what  caused  the  problems.   What  became  clear  as  one 
looked  around  the  health  department  was  that  the  same  people 
were  in  trouble  on  multiple  fronts,  and  our  one-discipline 
professional  workers  didn't  always  reach  them. 

We  found  that  the  same  family  had  all  kinds  of  health 
problems,  endless--and  was  also  having  all  kinds  of  probation 
problems  and  welfare  problems.   So  we  got  to  looking  at  it, 
wondering  if  we  could  really  separate  the  health  work  from  the 
welfare  work  from  the  probation  work  from  mental  health  work-- 
could  you  really  do  patient  care  by  having  an  army  of 
specialists,  each  working  on  one  aspect  of  a  person's  problems? 
You've  got  to  put  one  person's  problems  together,  and  treat  all 
of  a  person  with  good  timing  as  to  what  is  a  priority.  A 
multiprofessional  team  as  a  basis  with  one  or  another  member 
carrying  the  therapy  is  ideal.   A  cross-trained  professional 


189 


doing  the  basic  work  with  the  team  in  the  background  was  our 
goal. 

Crawford:   Goes  way  back. 

Blum:      Goes  way  back.   I  mean,  folks  were  writing  about  this  two 

thousand  years  ago.   We  wanted  to  give  it  a  practical  trial,  so 
we  cooked  up  what  we  called  the  multipurpose  worker;  well,  it 
was  really  a  multiservice  operation;  multipurpose  worker  was  a 
poor  term  because  that  got  us  into  nothing  but  trouble  with  all 
the  workers.   Nobody  wants  to  be  multipurpose;  everybody  wants 
to  be  specialized. 

We  approached  the  little  community,  Rodeo,  because  they 
were  isolated.   They  agreed:  yes,  they  would  love  such  a 
service  center.   We  said,  "We'll  give  you  a  health  center,  and 
out  of  this  health  center  will  work  mental  health  workers, 
nurses,  social  workers,  probation  workers;  and  the  county 
services  will  be  available  to  you,  near  at  hand.   We  can't 
always  get  you  what  you  need  here,  but  they'll  be  made 
available  as  soon  as  we  know  what  you  need." 

I  got  an  agreement  from  our  wise  county  administrator  to 
pull  all  this  stuff  together.   We  asked  the  probation  and  the 
health  and  the  welfare  departments  and  the  school  district, 
which  was  independent,  to  give  us  the  names  of  the  families  in 
trouble  that  they  were  working  on.   It  turns  out  that  there 
were  five  extended  families  who  were  the  crux  of  much  of  that, 
as  is  usual--a  few  people  are  taking  all  the  services  and  have 
all  the  trouble  —  these  five  families  have  a  couple  dozen 
people,  and  they're  always  in  trouble. 

We  asked  each  agency  how  many  workers  they  had  working  on 
these  families,  and  what  kinds  of  workers.   At  first  count  we 
found  ninety  workers  serving  these  five  families  over  the  past 
couple  of  years—so  you  know  the  kind  of  money  the  county  was 
spending  on  them.   I  dragged  that  information  over  to  the 
county  administrator- -he  was  a  character—and  he  said,  "Oh, 
you're  crazy.   It  can't  be.   You  go  back  and  count.   There's  no 
way  we  can  have  ninety  workers  in  a  little  town  like  Rodeo." 
Well,  it  turned  out  we  had  forgotten  to  count  the  probation 
workers.   By  the  time  we  added  it  all  up,  there  were  a  hundred 
and  twenty  workers . 

So  I  applied  for  a  grant,  and  we  got  a  half  a  million 
dollars ,  which  we  never  really  got  in  the  long  run  because 
that's  when  I  came  to  the  university,  and  the  USPHS  would  no 
longer  give  the  county  the  grant  when  I  was  gone. 


190 


Crawford:   What  happened  to  the  project? 

Blum:      Well,  it  stayed  on  without  any  grants,  and  it  worked  for  about 
ten  years,  from  about  1964  to  1974.   Each  of  the  departments 
picked  the  worker  who  was  appropriate,  and  in  several  cases  it 
was  the  worker  who  was  already  in  Rodeo,  but  in  our  nursing 
department  that  wasn't  true.   It  turned  out  that  our  nurses 
were  berating  any  nurse  who  wanted  to  go  there,  saying,  "This 
is  betraying  nursing." 

Crawford:   Kind  of  looked  down  on  it  as  compromising? 
Blum:      Compromising,  yes. 

Crawford:   Is  it  possible  to  do  all  those  things—be  an  employment 
counselor,  and  social  worker,  and  so  on? 

Blum:      No,  but  you  can  be  the  basic  person.   In  other  words,  you're 

the  primary  person,  and  you  obtain  more  refined  expertise  when 
you  need  it.   It's  like  the  physician  world.   The  primary  care 
practitioner  can  do  90  percent  of  it,  and  that  was  really  what 
that  was  all  about,  except  we  weren't  going  to  base  it  on 
physicians.   It  was  based  around  nurses  and  social  workers. 
The  probation  department  had  all  trained  social  workers,  too. 

Crawford:   How  did  the  doctors  like  it? 

Blum:       I  never  heard  from  them  because  they  still  got  their  referrals. 
They  were  outside  the  team,  you  see.   They  got  referrals;  they 
did  their  work,  and  paid  no  attention  to  it,  basically.   But 
our  workers  held  the  families  together. 

Before  we  got  started  in  the  field,  we  had  a  little  session 
with  the  big  shots  of  the  four  county  departments  and  the 
school  district  that  was  involved.   We  pulled  the  five  family 
cases  with  the  charts  from  each  agency.   The  very  first  one  we 
pulled--a  very  small  family—involved  a  girl  that  the  health 
department  knew  because  we  had  spent  a  fortune  on  her  through 
our  crippled  children's  program.   She  had  had  this  done,  and 
that  done,  and  she  never  really  thrived.   She  was  just  a  poor, 
miserable  little  kid;  she  was  not  retarded  or  anything  like 
that.   The  assigned  nurse  "knew  all  about"  the  case.   All  these 
workers  from  the  four  departments  knew  the  case,  or  so  they 
claimed. 

Contra  Costa  had  very  elegant  human  services  programs,  of 
which  all  the  workers  were  very  proud.   It  really  was  a 
remarkably  good  setup—still  is.   They  knew  all  about  the  case 
that  was  there— boasted  they  knew  their  cases. 


191 


Then  welfare  described  the  problems  with  the  family:  a 
ne'er-do-well  father  and  a  mother  who  was  not  with  it,  and  so 
on.   They  verified  what  the  nurse  had  to  say  from  the  health 
department  perspective. 

Probation  didn't  want  to  talk.   We  said,  "Come  off  it. 
This  is  part  of  your  assignment.   You're  delegated  to  sit  in  on 
this  and  go  to  work—never  mind  fooling  around."   So  they  gave 
us  what  they  knew  about  the  case,  which  was  a  case  of  incest 
with  this  little  girl,  and  all  that  the  health  department 
didn't  know  about  the  little  girl  was  about  the  incest,  and  all 
that  welfare  didn't  know  about  this  family  was  the  incest- -what 
was  the  matter  with  the  girl,  and  what  was  the  matter  with  the 
mother.   Just  shows  you  what  you  don't  know  if  you're  coming  at 
it  from  a  health  standpoint  or  a  welfare  or  a  school  or  a 
probation  standpoint.   This  was  the  first  case  we  studied. 

That  stopped  all  the  nonsense,  and  really  brought  everybody 
together  in  a  hurry  because  we  obviously  didn't  know  a  damn 
thing  unless  we  could  see  the  whole  case.   Yet  this  is  what  the 
rest  of  the  world  still  does.   Nobody  ever  looks  at  the  whole 
person  if  they  can  avoid  it. 

We  opened  up  the  Rodeo  Multipurpose  Center;  the  citizens 
had  a  big  meeting  and  told  us  what  they  wanted  out  of  it,  and 
everybody  was  looking  kind  of  happy.   Of  course,  nobody  knew 
about  this  first  case—but  everybody  seemed  to  be  moving  with 
the  intent  and  the  spirit  of  having  a  nearby,  easily  reached 
center  of  their  own. 

We  hired  a  wonderful  secretary--a  half  dozen  professional 
people  in  the  office  picked  this  girl  out.   She  was  somebody 
who  had  worked  around  the  community  as  a  secretary.   Then  after 
a  couple  of  months,  we  commenced  to  get  the  impression  that 
folks  were  coming  in  to  see  the  secretary.   This  was  not  a  new 
experience  for  us.   We'd  had  this  happen  in  alcoholism  clinics 
before.   She  was  a  great  gal.   She  could  take  care  of  many  of 
the  patients'  problems,  and  then  she  would  line  them  up  if  they 
needed  expertise—with  the  nurse  or  the  social  worker, 
probation  worker,  mental  health  worker— whoever  was  necessary. 
So  it  was  this  common  little  theme  of  being  able  to  talk  to  a 
good  human  being  that  was  meaningful  to  people  seeking  help 
with  whatever  kind  of  a  problem  they  had- -truly  one  stop. 

Then  the  nurse  and  social  worker  in  the  office  said,  "Can 
we  break  the  routine?   Instead  of  asking  the  patient  to  wait 
until  the  right  person  comes  back  because  the  secretary  says, 
'I  think  you  really  should  see  the  nurse,'  that  whoever  is  in 
the  office  take  these  cases  from  the  secretary.   In  this  way 


192 


there  would  always  be  a  professional  available  in  the  office, 
and  the  patient  wouldn't  have  to  come  back  another  day." 

This  was  the  multipurpose  approach.   By  experience,  all  the 
workers  were  discovering  that  most  of  them  could  do  much  of  the 
work  for  any  of  the  cases.   Our  nurses  knew  everything  the 
welfare  workers  did,  and  vice  versa  to  a  great  extent—not  the 
detailed  health  care  stuff,  but  very  close  to  it.   The  net 
result  was  that  that's  how  the  center  began  to  operate.   The 
secretary  would  see  people,  then  would  assign  them  to  whoever 
was  in  unless  it  was  clear-cut  they  had  to  go  to  special  care, 
which  was  arranged.   This  approach  changed  the  life  of  the 
center,  and  it  really  worked;  it  worked  beautifully. 

Crawford:   And  you  had  to  come  into  the  center? 

Blum:      The  center  was  in  Rodeo,  and  just  for  Rodeo  residents. 

Otherwise,  our  offices  for  the  people  in  the  area  were  in 
Richmond,  and  the  welfare  offices  were  in  a  different  building 
in  Richmond;  the  mental  health—well,  hell,  they  were  in 
Martinez;  the  school  people  were  in  Rodeo.   The  workers  came  to 
the  center  and  were  available  to  the  locals.   Previously  the 
people  traveled  to  one  or  more  of  these  offices.   There  was  no 
public  transportation  and  patients  were  killing  themselves  over 
keeping  conflicting  appointment  times  and  places.   I  finally 
saw  this  Rodeo  approach  in  real  operation  in  Canada  years 
later;  in  Australia;  in  Finland;  in  Sweden. 

Crawford:   Before  your  work  on  the  Rodeo  center  you  gathered  data  on 
multipurpose  workers  in  Europe,  didn't  you? 

Blum:      Yes,  I  went  to  France  and  England  and  to  Denmark  and  Finland. 
I  told  you  about  Ollie  Randall.   She  was  the  Ford  Foundation's 
super  social  work  consultant,  and  she  heard  that  we  were 
working  at  putting  this  together  in  1960-61. 

Crawford:   She'd  been  working  in  the  field  after  World  War  I? 

Blum:      Yes.   She  came  to  visit  us  —  looked  us  up—and  wanted  to  hear 
about  this  multipurpose  worker  thing,  and  she  was  so  pleased, 
and  said,  "Well,  this  is  fabulous.   You  know  what?  At  the  end 
of  World  War  I,  when  I  was  working  in  France,  we  set  this  up 
there."   [laughter] 

Crawford:   Similar  thing? 


193 


Studying  Health  Care  Systems  in  Europe  on  a  1962  WHO  Fellowship 
and  a  Later  Study  of  Health  Care  in  Australia 


Blum:      Same  thing.   By  the  time  I  finished  listening  to  her,  I 
realized  this  might  be  new  for  the  States,  but  it  wasn't 
exactly  new  for  the  rest  of  the  world.   So  that  started  me,  and 
I  got  an  eight -week  WHO  [World  Health  Organization]  fellowship 
in  1962  for  a  tour  of  Europe  that  I  designed.   It  took  me  to 
places  that  were  doing  this  sort  of  thing:  amongst  others, 
France,  where  they  had  really  carried  it  a  long,  long  way 
formally,  to  the  point  that  some  of  their  nurses  were  also 
trained  as  social  workers  and  some  of  the  social  workers  were 
also  trained  as  nurses. 

I  went  to  a  big  eight-story  building  in  Paris,  where  these 
people  were  being  trained,  and  part  of  that  building—the  top 
floor—was  a  nursery  for  foundlings.   The  students,  who  were 
getting  the  training  in  nursing  and  social  work  combined  in  a 
total  of  three  years,  had  to  take  care  of  these  foundlings  as 
part  of  their  training.   So  here  they  are  all  cooing  and 
working  with  these  kids,  and  you  realize  right  away  that  many 
of  the  images  that  we  have  of  babies  are  poorly  conceived. 
Here  are  the  little  babies  sitting  in  slanting  kind  of  little 
troughs,  facing  one  another-- just  three,  four,  five,  six  months 
old—really  holding  forth,  you  know. 

Crawford:   Just  conversing! 

Blum:      And  we  supposedly  know  that  babies  don't  do  that,  but  nobody 

ever  got  them  to  try.   We  say  babies  are  this  way  until  they're 
a  certain  age.   Well,  any  event,  part  of  the  training  these 
people  got  was  to  take  care  of  babies  because  they  hadn't  yet 
had  their  own  families.   Then  when  I  went  out  in  the  field  and 
got  to  Orleans,  they  took  care  of  me,  showed  me  the  district 
offices,  and  I  met  the  workers.   I  went  with  the  health  officer 
to  lunch— let  me  tell  you,  that  was  an  affair— one  of  the 
finest  meals  I've  ever  eaten— at  the  railroad  station. 

II 

Blum:      In  this  setting  they  had  these  multiskilled  workers.   One  of 

them  was  paid  for  by  the  railroads  because  there  were  a  lot  of 
railroad  workers  in  the  area.   One  of  them  was  paid  for  by 
agriculture  because  there  were  a  lot  of  farmers,  and  another 
one  was  paid  for  by  the  health  services,  still  another  was  paid 
for  by  some  other  agency.   They  all  worked  out  of  the  same 
office,  but  the  only  difference  was  that  if  you  were  a  railroad 
worker,  you  went  to  the  one  that  was  paid  for  by  the  railroads. 


194 


The  workers  were  hired  and  paid  by  the  source  of  pay,  but 
each  covered  all  the  bases;  they  did  the  health,  welfare,  and 
mental  health  kinds  of  things.   That  was  kind  of  shocking 
because  the  professions  wouldn't  let  you  get  away  with  that  in 
the  States.   These  workers  knew  one  another's  business,  they 
knew  the  community  inside  out,  and  they  covered  all  the 
services—not  like  that  mess  I  told  you  about  where  innumerable 
visiting  workers  from  three  separate  agencies  never  knew 
anything  about  the  troubled  little  girl  who  was  a  victim  of 
incest,  a  well-kept  secret  by  the  social  workers  in  probation. 

I  went  from  there  back  to  Paris  to  see  the  national  head  of 
the  nursing-social  worker  operations.   There  was  a  lady  in 
charge  —  and  she  spoke  English,  thank  god--and  I  said  to  her, 
"Where  are  all  the  agreements  that  hold  this  together?  Here's 
workers  from  four  separate  organizations,  all  working  side  by 
side,  taking  care  of  folks  in  Orleans."   "Well,"  she  said, 
"that's  very  simple.   There's  really  not  much  to  that.   Our 
organizations  just  made  up  their  mind  to  do  it."   She  pulled 
open  a  file  drawer,  picked  up  about  three  or  four  inches  of 
files  and  said,  "These  are  all  the  agreements  for  France  about 
who  does  what."  You  know,  in  the  United  States,  it  would  be  a 
thousand  tons  of  agreements. 

Crawford:   Why? 

Blum:      Because  every  health  department  goes  its  own  way.   Every 
welfare  department  in  every  city  and  every  county  does 
likewise.   In  France  a  lot  is  settled  at  the  national  level.   1 
couldn't  get  over  it—these  files  covered  all  the  agreements. 
Well,  if  I'd  never  seen  the  workers,  I'd  say  it  was  probably  in 
their  minds,  but  when  you  see  them  at  work--. 

From  there  I  went  to  Finland,  and  I  saw  comparable  things. 
It's  more  on  a  village-by-village  basis  in  Finland,  and  less 
well  organized  in  Helsinki.   From  there,  I  went  to  England  to 
see  the  combined  human  services,  which  weren't  combined  very 
well.   I  remember  visiting  a  home  in  Oxford,  and  the  lady  had 
to  contend  with  about  twenty  home  visitors,  just  like  here. 
She  was  complaining  to  me  as  an  outside  person  about  the 
fantastic  imposition  of  all  the  home  visitors  on  her  time.   But 
England  had  more  services  than  the  rest  of  the  world  has  ever 
seen.   We  never  had  services  that  good  or  inclusive,  but  one 
can't  inflict  them  all  one  by  one  through  innumerable 
specialized  workers  on  one  poor  lady  who  has  a  couple  of  little 
kids  and  no  husband.   They  were  driving  her  crazy.   You've  got 
to  report  to  a  clinic  at  this  hour,  but  at  the  same  time  you've 
got  to  be  over  there  for  something  else;  and  nobody's  paying 
any  attention  to  the  real  needs  of  the  person. 


195 


Crawford: 
Blum: 


Crawford: 
Blum: 


This  was  just  the  opposite  of  our  Rodeo  situation,  or  the 
French  situation,  where  you  were  put  in  the  hands  of  one  person. 

In  Finland,  they  got  away  from  that  pretty  much.   A  single 
public  health  nurse  would  be  in  the  community  and  in  the 
schools,  and  would  be  doing  the  social  work  and  covering  all 
kinds  of  human  needs.   She  worked  as  part  of  a  team  with  the 
local  doctor  who  did  part  private  fee-for-service  practice  and 
part  public  health,  caring  for  everyone  in  his  area. 

In  Denmark,  in  those  days,  and  this  was  in  the  sixties, 
people  didn't  trust  social  workers,  because  the  ethos  of  the 
Danish  people  was  that  you  ought  to  do  these  things  for  your 
family,  friends,  and  neighbors.   They  didn't  want  professionals 
coming  in  to  help  a  family  because  the  people  in  the  community 
should  help  one  another.   The  health  workers  were  specialized 
enough  so  that  they  were  okay.   Denmark  had  a  very  interesting 
family  practitioner  and  public  health  nurse  team  in  every 
little  community.   Social  workers  were  a  late  arrival  on  the 
scene,  because  people  said,  "Shouldn't  we  be  doing  this 
ourselves?"  As  I  learned--!  spent  quite  a  bit  of  time  there- 
one  of  the  biggest  threats  you  can  make  to  a  professional  was 
that  "I'm  going  to  commit  suicide,"  which  really  was  a  threat 
to  the  family  and  neighbors  as  well;  it  said,  "Everybody's 
failed  me." 

They  do  have  a  high  suicide  rate. 

Yes,  the  highest  in  the  world.   And  this  was  probably  a  way  to 
vent  their  hostility.   They  had  no  murders.   When  I  was  there 
they  could  remember  only  one  murder  five  years  back  on  the 
Copenhagen  waterfront,  but  suicides—yes .   This  also  was  a 
nasty  threat  for  psychiatrists,  even  those  who  had  been  trained 
in  the  U.S.;  they  got  shaky  about  their  professional  competency 
or  caring  when  somebody  threatened  suicide.   There  are  major 
different  cultural  things  that  have  to  be  taken  into  account; 
quite  fascinating. 

You  wrote  up  the  visit. 
Yes.1 

I'm  going  to  follow  this  set  of  concerns  forward  over 
several  decades  because  of  the  theme  of  multiservice  care  for 
persons,  families,  and  communities.   In  later  years  I  got  to 


"'The  Multipurpose  Worker,  A  Family  Specialist." 
Public  Health,  1966. 


American  Journal  of 


196 


Crawford: 
Blum: 


wandering  around  the  world  for  other  reasons  and  found  many 
different  human  services  —  and  some  beautiful  examples  of 
combined  services,  well-coordinated  teams,  and  multi-cross- 
trained  workers.   Under  the  cross-training  rubric  there  should 
be  a  lot  of  educational  effort  put  into  creating  multipurpose 
human-service  workers  as  a  result  of  the  economic  pressures 
posed  by  HMOs.   Maybe  it's  going  to  start. 

In  Australia  rather  recently—in  the  1980s  — it  turns  out 
that  there  were  several  physicians  who  had  escaped  from  South 
Africa,  a  family  that  had  been  involved  in  the  world's  really 
pioneer  community-oriented  primary  care  (COPC)  with  the  Zulus, 
saying  you  can't  provide  health  care  just  in  the  way  you  were 
taught  in  medical  school;  it's  got  more  to  do  with  who  the 
people  are  than  with  who  you  are.   You've  got  to  pay  attention 
to  religion,  to  customs,  to  the  social,  economic  circumstances, 
and  to  the  community  and  the  individual  that  results.   It  was 
community- oriented  primary  care— it  would  take  the  community 
into  account.   Who  are  these  people?  The  key  figure  was  Sidney 
Kark.   When  South  Africa  became  intolerable  he  went  to  Israel- 
took  his  ideas  there.   He  had  two  cousins  who  were  family 
practitioners  also,  and  they  went  to  Australia.   One  cousin  was 
Sidney  Sax. 

It  turns  out  that  in  years  gone  by,  Sidney  Sax  had  been  a 
visitor  here  about  the  time  we  built  our  home.   I  took  him  home 
for  something  or  other,  gave  him  some  sherry,  we  sat  and  looked 
at  the  view  together.   When  I  went  to  Australia  for  two  or 
three  months,  some  fifteen  years  later,  people  hooked  me  up 
with  various  people  to  visit,  and  he  was  one  of  them.   When  I 
got  to  Canberra— the  national  capital—he  really  took  over  and 
we  went  everywhere;  he  did  everything  for  us.   I  finally  said, 
"I  don't  see  why  you  should  do  this."  He  was  the  head  of  the 
Institute  of  Health  and  Welfare.   He  said,  "Well,  you  did  it 
for  me  fifteen  years  ago."   [laughs] 

And  you  had  forgotten? 

I'd  forgotten.   He  said,  "I  remember  sitting  in  your  living 
room"--then  it  commenced  to  come  back  to  me— "sipping  sherry 
and  looking  at  the  beautiful  world."  Australia  had  had  what 
they  called  a  Liberal  government,  meaning  anything  but  a 
liberal  government,  for  years  and  years  and  years.   Then  Labour 
came  in  in  the  early  1970s—a  Labour  government --and  they  came 
in  on  a  promise  of  universal  health  care,  which  Britain  already 
had,  you  see.   It  was  another  world- -not  like  here.   Sidney  Sax 
had  been  picked  to  be  the  Minister  of  Health  and  Welfare  [by 
Labour] ,  but  they  figured  that  he  would  be  shadow  minister  in 
the  British  tradition  because  they  could  never  win  the 


197 


election.   Well,  they  won  the  election,  and  the  first  night 
they  were  sitting  there  in  Canberra—they're  in. 

The  new  prime  minister  said,  "We  ran  on  a  platform  of 
health  care  for  everybody,  Sidney.   When  can  you  have  me  a  plan 
for  the  works?"  He  replied,  "In  six  months,  nine  months,  we'll 
have  it  all  laid  out—eighteen  months."  And  the  prime  minister 
looked  at  him  and  said,  "Eighteen  hours .   I  want  it  tomorrow." 
And  they  did  it.   You  don't  have  to  work  out  all  the  goddamned 
details. 

Part  of  what  they  did  was  to  offer  funding  for  multihuman 
service  units  in  every  state  in  Australia;  multihuman  service 
units  including  health,  as  well  as  universal  health  care. 
There  was  money  for  it.   Every  medical  school  in  Australia  was 
forced  to  have  a  unit  of  social  health  planning,  and  Sidney 
just  sat  down  and  cooked  it  all  up  essentially  overnight.   He'd 
had  this  wonderful  background  in  South  Africa,  thinking  about 
people  as  whole  persons  who  were  a  part  of  a  community. 

Crawford:   Where  it  had  worked. 

Blum:      Where  it  had  worked—with  very  disadvantaged  people,  to  be 

sure.   So  every  Australian  medical  school  does  have  a  social 
health  department  to  this  day. 

Crawford:   It's  a  good  system? 

Blum:      For  medical  school?  Yes,  it's  imperative  to  know  something 

about  human  beings  and  the  relationships  between  them  and  their 
society. 

Crawford:   Does  it  work  out  in  the  communities? 

Blum:      The  Labour  government  only  lasted  a  couple  of  years  because 
they  didn't  carry  the  upper  house- -the  equivalent  of  the 
British  Lords.   And  that  house  had,  in  Australia,  the  authority 
to  sign  off  on  money  bills,  so  the  lower  house,  which  Labour 
carried,  put  all  these  programs  into  place,  and  the  upper  house 
wouldn't  fund  them. 

After  a  couple  of  years,  government  debts  were  mounting— 
the  money  wasn't  being  voted,  you  see.   So  the  conservative 
people  in  the  government  appealed  to  the  Governor  General  of 
Australia,  appointed  by  Her  Majesty,  the  Queen  of  England, 
saying,  "You've  got  to  do  something  about  this."  This  business 
of  being  a  Commonwealth  country  is  not  without  its  interesting 
angles.  And  the  Labour  government  was  turned  aside;  the 
government  was  handed  back  to  the  Conservatives.   If  you  keep 


198 


current  on  Australian  politics  you  will  hear  about  this  episode 
as  part  of  the  reason  Australia  will  probably  be  leaving  the 
Commonwealth  soon. 

But  overall  it  was  a  tremendous  new  program.   To  be  sure, 
many  pieces  of  it  fell  apart,  but  I  was  there  ten  years  later 
and  there  were  still  many  of  these  community  health  centers. 
Some  of  them  weren't  called  that,  but  they  were  multiservice 
centers  providing  for  all  kinds  of  services  in  one  place  with 
an  integrated  team  of  human  service  specialists. 

One  of  them  was  a  fantastic  operation  in  Adelaide- -until 
you  see  it  you  can't  believe  it--in  a  newer  part  of  the  city,  a 
working  man's  community  with  a  lot  of  poor  people  living  in 
government  housing;  a  lot  of  women  and  kids  with  no  husbands;  a 
huge,  beautiful  new  pair  of  schools.   Tied  to  the  schools  are 
the  service  arms  of  the  community.   So  here's  a  library,  but 
it's  also  the  health  library,  and  welfare  library,  and  the 
nutrition  service.   There's  a  swimming  pool;  there's  a  gym; 
there's  all  this  available  to  the  community.   It's  not  just  a 
school.   There's  a  physician,  nurses,  social  workers  working  in 
this  center. 

Then  I  went  to  one  further  out  from  Adelaide ,  known  as 
Friendly  Farms.   I  met  the  doctor  who  started  it--he'd 
graduated  when  the  Labour  government  came  in.   The  community 
had  been  built  up  to  house  the  workers  at  a  huge  new  auto 
factory  at  the  periphery  of  Adelaide.   It  was  not  very 
successful—big  layoffs  ultimately—and  a  lot  of  poor  people. 

This  doctor  was  fresh  out  of  school  with  a  tiny  office, 
about  eight  by  eight.   He  came  there  while  business  was  still 
booming.   What  he  discovered  was  that  people  kept  coming  for 
care,  but  they  really  were  mostly  disoriented.   They  were 
newcomers  to  Adelaide—they  'd  come  from  other  parts  to  get 
jobs  —  and  they  were  just  having  babies,  and  new  families,  and 
were  having  a  hard  time  getting  their  lives  together. 

Every  night  he  had  classes,  talking  with  people  who  had 
similar  problems,  and  this  is  how  his  practice  started. 
Instead  of  giving  them  more  pills  and  more  vitamins,  he  was 
looking  at  the  social,  human,  economic,  health  side  of  the 
whole  thing.   He  was  a  remarkable  physician,  and  his  practice 
went  like  wildfire. 

The  next  thing  you  know,  he  had  a  building,  and  then  he 
hired  a  social  worker—and  this  is  a  doctor,  you  see,  and  he's 
not  going  to  get  money  out  of  it  because  it  was  all  paid  for. 
It's  not  the  usual  use  of  medical  social  work  as  we  think  of  it 


199 


Crawford: 
Blum: 


in  the  U.S.A.,  which  is  to  get  dollars  out  of  people's  pockets 
to  pay  for  services,  which  is  what  happened  in  the  hospital 
business,  or  get  them  out  when  it's  time.   This  was  the  real 
thing  to  help  people.   He  had  mental  health  workers;  he  had 
public  health  nurses,  and  this  is  a  private  practitioner.   This 
was  not  government.   True,  government  was  underwriting  all  the 
human  services,  but  he  was  putting  them  together  so  that  a 
patient's  needs  were  understood  and  met,  no  pills  for  worry,  no 
surgery  for  worry-produced  bowel  distress. 

We  visited  this  center.   It  was  a  big,  beautiful  plant.   We 
got  there,  sat  around  and  chatted  with  him,  and  he  brought  in 
his  head  administrator,  who  used  to  be  the  superintendent  of 
schools  —  a  fairly  young  man.   Much  of  his  training  was  in 
bringing  people  together,  and  they  were  teaching  one  another. 

This  man  had  taken  over  as  the  doctor's  majordomo,  his 
administrator.   But  when  we  were  there,  the  auto  industry  was 
dying  in  Australia  and,  at  this  time,  he  said  that  it  was  very 
interesting  that  they  still  had  all  these  classes,  and  patients 
groups  still  met  with  the  doctor,  but  they  had  a  whole 
different  set  of  problems  now.   The  kids  were  growing  up,  and 
some  of  them  were  starting  to  go  away  to  school;  some  of  the 
families  were  breaking  apart,  and  there  was  a  whole  series  of 
new  social  phenomena  that  were  making  these  people  want  to  see 
the  doctor,  and  they  were  now  dealing  with  new  social 
situations,  but  still  on  the  basis  of  working  things  out 
together.   This  was  covering  the  bases.   Fabulous! 

When  did  you  first  see  this? 

That  was  late,  already,  fifteen  years  after  Rodeo.   Of  course, 
in  Canada  you'd  see  things  like  that.   In  '77,  I  had  a 
fantastic  year--I  took  a  sabbatical.   Went  across  Canada  seeing 
multiservice  clinics  all  the  way  from  Vancouver  Island,  where 
they  had  some  wonderful  clinics  with  hundreds  of  volunteers 
right  near  the  Empress  Hotel  in  Victoria.   It's  in  an  older 
neighborhood,  a  nice  neighborhood,  but  there  are  a  lot  of  old 
people,  a  lot  of  problems.   They  had  this  joint  clinic  with  all 
kinds  of  services  and  a  couple  hundred  volunteers  and  were 
servicing  all  kinds  of  people.   Most  of  the  servicing  is  not 
straight  health  care  such  as  would  be  reflected  here  in  terms 
of  pills,  and  surgery,  and  doctors  visits.   There  it  was 
concern  for  loneliness,  for  some  Alzheimer's,  and  some  this, 
and  some  that.   Also,  a  lot  of  hippies  had  moved  into  this 
neighborhood  as  it  was  getting  old  and  less  expensive,  and  they 
had  very  different  demands.   They  had  drug  problems,  growing-up 
problems,  which,  again,  are  not  medical  in  the  usual  sense. 


200 


We  got  to  see  it  all  operate,  and  to  see  how  apartment 
house  people  worked  it  out  with  the  clinic.   They  would  call  on 
the  clinic  if  they  had  problems  of  any  kind.   In  return,  the 
clinic  would  notify  apartment  house  managers  and  say  you've  got 
somebody  there  that  you've  got  keep  an  eye  on.   It  was  just  a 
marvelous  cooperative  venture  of  a  health  clinic  with  all 
elements  of  the  community.   They  had  a  large  group  of  people 
who  by  means  of  a  health  clinic  were  concerned  with  other 
people's  problems. 

Studying  the  diverse  approaches  taken  in  Australia  to 
provide  health  care,  much  of  it  started  under  the  brief  tenure 
of  the  Labour  government,  brought  us  to  Alice  Springs.   It's  at 
the  very  center  of  Australia  and  home  to  a  very  large 
Aboriginal  population.   As  in  much  of  Australia,  the 
Aboriginals  were  just  sort  of  tolerated  here,  a  kind  of 
subclass,  enjoying  more  nearly  the  status  of  our  American 
Indians  where  there  are  significant  numbers  of  them,  rather 
than  the  more  formal  disadvantaging  offered  our  black  people. 

Their  culture  is  also  more  nature-  and  land-based,  with  no 
corporate  or  individual  ownership  of  land,  farms,  not  unlike 
our  Indians.   In  fact,  when  we  were  there  we  had  just  followed 
a  Navajo  delegation  interested  in  learning  about  this 
particular  Aboriginal  health  center's  activities. 

It  had  been  founded  over  a  half  dozen  years  earlier  by  a 
professor  of  medicine  from  the  University  of  British  Columbia. 
The  doctor  currently  in  charge  was  a  young  Australian  with  half 
a  dozen  kids  who  very  much  wanted  a  public  health  degree  from 
UC  Berkeley,  but  couldn't  afford  to  get  away. 

On  the  day  of  our  visit,  the  founding  doctor,  who  had  gone 
on  to  create  a  medical  school  in  New  Guinea,  had  come  back  to 
see  how  things  were  doing.   We  sat  together  for  most  of  a  day 
and  heard  a  wonderful  story. 

The  Aboriginals  with  their  Canadian  doctor  had  gotten  a 
grant  from  the  national  Labour  government  to  start  a  clinic  and 
had  gotten  involved  in  doing  all  the  things  that  they  thought 
were  good  for  their  health.   After  getting  the  doctor  and  a 
nurse  they  had  branched  out  and  set  up  a  small  bank  of  their 
own  because  they  didn't  trust  the  big  ones,  probably  wisely  so. 
This  was  done  because  as  they  came  in  from  their  station  jobs, 
they  soon  wasted  or  drank  up  all  their  money  because  they  had 
no  place  to  keep  it  and  no  use  for  it. 


201 


Another  early  step  was  the  creation  of  a  pharmacy  in  the 
clinic  so  they  could  get  what  was  prescribed  without  getting 
robbed  or  insulted. 

Another  step  of  a  major  sort  was  their  creation  of  a  radio 
station,  which  soon  served  many  purposes.   It  taught  English  to 
the  huge  Aboriginal  population  within  its  thousand-mile  radius, 
the  heart  of  Australia's  Aboriginal  population.   By  popular 
request  it  branched  out  into  educating  about  cattle  raising  for 
cattle  stations  and  their  workers,  which  were  generally 
Aboriginals  who  were  becoming  stockmen.   The  station  did 
cultural  things,  news  and  whatever  Aboriginals  wanted. 

In  one  of  our  excursions  we  visited  and  ate  at  a  huge 
cattle  station,  were  cared  for  by  Anglos  but  saw  many 
Aboriginals  about.   It  turned  out  that  this  and  an  adjacent 
station  were  now  owned  by  the  Aboriginals  who  operated  the 
health  center  and  were  learning  how  to  run  it  from  the  Anglos, 
as  well  as  raising  cattle. 

With  their  savings  they  bought  the  ranches  from  Anglos  who 
could  no  longer  make  a  go  of  it  with  their  jeeps  and  airplanes. 
The  "Abos,"  as  they  are  usually  called,  lived  with  their  stock, 
moving  them  for  food  and  water  as  they  had  always  done  for 
themselves.   They  were  earning  money  and  buying  back  their 
land,  and  learning  about  ownership,  which  had  never  been  part 
of  their  lives  or  culture. 

The  health  center  brought  in  a  lawyer  to  look  after  the 
legal  needs.  Arrests  in  Alice  Springs  were  primarily  an  Abo 
phenomenon  even  though  these  people  were  a  minority. 

Before  a  year  was  out,  their  arrests  were  less  than  10 
percent  of  the  total  because  the  lawyer  looked  into  each  arrest 
and  the  fun  was  over  for  the  Alice  Springs  police  force. 

The  Abos  had  had  houses  created  for  them,  simple  affairs, 
which  they  had  no  intention  of  occupying,  as  they  preferred 
living  outside  in  a  simple  shade-providing  structure.   But 
their  kids  were  being  disadvantaged  by  their  non-dwelling 
lifestyle.   The  health  center  took  charge  of  two  schools  which 
served  primarily  Abos,  arranged  for  showers,  laundry,  meals, 
health  care,  and  a  couple  of  school  buses  to  facilitate 
covering  their  needs  and  education. 

The  health  center  also  serviced  anyone,  as  well  as  being 
free  for  Abos.  A  little  sign  at  reception  said,  "Please  pay 
what  you  can."  There  were  backpacks  scattered  around  as  this 


202 


was  a  stop  for  mostly  college  students  from  the  States  or 
Europe. 

As  we  were  there,  an  Aboriginal  man  came  in  for  his  follow- 
up  visit.   He  had  been  hit  by  a  car  a  few  weeks  preceding  and 
had  been  taken  to  emergency  at  the  adjacent,  beautiful,  new 
community  hospital.   He  spoke  no  English,  was  cursorily 
examined,  and  sent  away. 

Fortunately,  he  stopped  by  the  clinic,  where  they  saw  that 
he  was  leaking  cerebro-spinal  fluid  from  one  ear,  an  absolutely 
diagnostic  sign  of  a  skull  fracture  and  a  dangerous  one  as  it 
meant  there  was  an  open  passageway  for  infection  to  the  brain. 
The  doctor  had  picked  up  the  phone,  gotten  the  M.D.  in  charge, 
and  the  patient  was  promptly  admitted.   This  was  their  special 
duty,  keeping  an  eye  on  the  quality  of  care  at  the  community 
hospital,  and  forcing  it  to  change  its  practices  for  the 
better. 

Some  health  center,  was  all  I  could  think.   When  I  asked 
the  founding  and  the  current  doctors  what  was  their  purpose  in 
making  this  the  kind  of  a  health  center  that  was  relevant  to 
the  lives  of  the  Abos,  they  immediately  chimed  in,  "We  want  to 
give  them  a  breathing  spell,  to  decide  do  they  want  to  join  in 
with  the  Euro  lifestyle,  and  if  so,  we  will  help  them  come  in 
with  a  more  nearly  equal  chance  of  succeeding,  or  do  they  want 
to  go  back  to  their  walkabout,  communal-pastoral-desert 
lifestyle?  We'll  help  them  in  whatever  they  choose.   The 
health  center  is  the  logical  place  from  which  to  help  the 
Aboriginals  navigate  the  never-ending  social  changes  which 
determine  their  well  being." 

Marian  and  I  had  to  go  to  the  center  of  Australia  to  hear 
this,  spoken  as  it  never  would  be  anywhere  else,  at  a  health 
center . 


Birth  Control  Programs  and  Governor  Pat  Brown 


Blum:      There  were  other  interesting  things  that  happened  in  Contra 
Costa.   Did  we  ever  go  through  birth  control!   When  I  first 
came  to  the  Contra  Costa  health  department,  maternal  and  child 
health  was  a  big  thing.   One  of  the  things  that  you  had  to 
offer  if  you  were  going  to  be  serious  about  maternal  health  was 
birth  control;  some  women  shouldn't  be  having  a  child  at  one  or 
another  time  in  their  lives. 


203 


But  no  government  agency  west  of  the  Mississippi  or  north 
of  the  Ohio  ever  did  birth  control,  apparently.   It  was  done  in 
the  South—and  for  a  good  enough  reason—by  nice  white  folks 
who  meant  well  by  serving  nice  black  folks.   However,  it  was  an 
intolerable  idea  out  here,  particularly  wherever  Catholicism 
was  a  significant  force,  or  thought  to  be. 

We  thought ,  There ' s  no  use  running  an  MCH  program  if  we 
can't  do  the  most  important  things,  which  for  some  women, 
certainly  as  far  as  sparing  their  life  is  concerned,  just  might 
be  birth  control.   Big  families  that  are  in  a  disaster  mode 
can't  keep  adding  babies  every  year  just  casually. 

We  sat  down  and  worked  it  through,  and  decided  that,  yes, 
we  would  undertake  to  provide  birth  control  as  part  of  the 
maternal  and  child  health  program.   We  created  what  we  called  a 
"white  paper."  Dr.  Yoshiye  Togasaki  did  the  homework  on  that. 
As  I've  said,  she  was  my  classmate  from  Harvard,  a  pediatrician 
now  full  time  in  the  health  department.   She  developed  a  white 
paper  which  was  based  on  some  very  ethical  principles. 

For  example,  if  you  knew  that  somebody  needed  this  service 
and  the  only  thing  between  you  and  providing  it  was  doing 
it  —  there  were  no  laws  against  it,  just  an  unwritten  political 
law  that  government  shouldn't  be  involved.   But  if  you're 
really  playing  the  doctor  and  advising  a  woman  about  her  health 
and  her  survival,  maybe  you'd  better  worry  about  the  things 
that  were  relevant  to  her  survival,  such  as  birth  control. 

Then  our  white  paper  went  further  to  point  out  that  any 
other  woman  who  had  money  and  didn't  depend  on  the  health 
department  for  services  could  and  would  get  such  services 
privately,  so  there  was  nothing  terribly  immoral  about  it.   It 
was  just  that  if  you  had  money  you  could  have  this  necessary 
service,  and  if  you  didn't,  you  couldn't  because  you  depended 
on  the  health  department.   The  white  paper  took  the  moral  stand 
that  poverty  should  not  be  the  determinant  of  risking  death  or 
of  ensuring  life. 

We  hauled  it  around  to  the  California  Conference  of  Local 
Health  Officers,  and  got  approval  with  the  exception  of  one  vote 
--the  Catholic  health  officer  of  Santa  Barbara  County,  which  had 
a  big  Catholic  population  even  in  those  days.   It  would  probably 
be  the  early  sixties  when  we  finally  brought  it  off. 

The  Conference  of  Local  Health  Officers— a  legally 
constituted  entity— adopted  the  white  paper  as  its  policy.   But 
there  wasn't  anybody  going  to  do  anything  about  it.   Then  we 
passed  it  on  to  the  California  State  Board  of  Health.   In  those 


204 


pre-Reagan  days,  early  to  mid-sixties,  it  was  a  very  powerful, 
independent  body,  like  the  Regents  are  supposed  to  be;  they 
were  appointed  by  the  governor  and  the  legislature.   It  was 
really  a  state  board  of  health.   It  was  among  the  best  of  the 
state  health  boards  and  really  had  a  lot  of  power.   There  were 
always  powerful  representatives  on  it  from  the  California 
Medical  Association.   To  be  sure,  they  didn't  always  see  eye  to 
eye  with  non-physicians  about  public  health  measures,  but 
generally  speaking  they  did  do  what  was  best  for  Calif ornians. 

I  remember  the  last  chairman  of  the  board  was  Roger 
Eggeberg,  who  was  dean  of  the  medical  school  at  USC  and 
subsequently  chief  of  medical  services  for  Douglas  MacArthur. 
He  was  a  wonderful  guy,  a  huge  man—huge  in  spirit—a  good 
mind.   The  state  board  adopted  our  white  paper  as  California 
public  health  policy.   However,  it  didn't  motivate  anybody 
except  us.   We  got  Planned  Parenthood  to  set  up  our  first 
clinics  for  us  because  we  had  never  done  a  birth  control  or 
family  planning  clinic  ourselves. 

Crawford:   What  was  the  format  of  the  clinic? 

Blum:      Oh,  it  was  a  straight  health  department  clinic.   Public  health 
nurses  were  the  mainstay  of  the  health  department;  they 
referred  people  into  various  clinics:  ours,  others,  even  over 
to  the  hospitals  in  Berkeley  or  Oakland,  even  San  Francisco  or 
wherever,  if  necessary.   In  our  clinics  we  hired  physicians  to 
do  the  medical  work,  the  nurses  and  volunteers  assisted  and 
educated  the  patients  at  each  clinic  session. 

Crawford:   Was  it  an  aggressive  program? 

Blum:      I  would  say  it  was.   If  a  public  health  nurse  thought  that  one 
of  the  people  she  was  assisting  needed  family  planning,  she 
would  refer  her  to  one  of  our  clinics.   Planned  Parenthood 
provided  staff  from  their  Oakland  office  to  come  and  train  our 
nurses  in  our  own  clinics.   Some  of  our  people  may  have  known 
all  about  the  procedures,  but  we  hadn't  done  it  ourselves,  it 
was  not  something  that  we  regarded  ourselves  as  very  expert  at. 
Just  the  other  day  I  was  with  one  of  the  people  who  remembered 
how  she'd  come  to  help  us  in  Contra  Costa  County. 

As  helpful  as  they  were  about  helping  us  set  up,  Planned 
Parenthood  said,  "Why  don't  we  come  in  and  do  all  the  clinics 
for  you?"   I  really  could  see  the  end  of  the  program  in  a  hurry 
because  if  they  offered  to  do  it,  then  the  county  would  never 
do  it.   But  we  knew  that  if  they  had  one  clinic  in  Oakland, 
they  weren't  going  to  have  much  more  in  Contra  Costa;  they  were 
going  to  meet  a  tiny  fraction  of  the  needs,  and  keep  us  from 


205 


doing  the  job.   Yet  it  would  give  our  board  of  supervisors  an 
excuse  to  avoid  taking  on  a  hot  potato,  but  what  a  lousy  excuse 
it  would  be.   We  ultimately  had  about  twenty  clinics  monthly  in 
different  parts  of  the  county. 

Crawford:   And  why  would  that  be  in  Planned  Parenthood 's  best  interest? 

Blum:      There  was  nothing  evil  about  their  intentions.   It  was  just 

part  of  the  "good  work,"  as  seen  from  their  standpoint.   From 
our  standpoint,  it  was  just  a  way  of  ultimately  keeping  us  from 
doing  the  size  of  a  job  that  was  needed  in  our  county. 

They  finally  quieted  down  and  taught  us  how  to  do  what  they 
knew  very  well.   They  created  a  very  superb  service.   One  of 
their  board  got  us  a  grant  to  get  started  from  an  unnamed, 
numbered  bank  account  in  Switzerland.   You  might  say  that  we 
were  sent  a  gift  of  birth  control  services. 

Crawford:   Who  was  that? 

Blum:      I  don't  know  who  created  it.   I  would  guess  it  was  a  woman.   I 
think  it  was  a  Dr.  Smith,  associated  with  Children's  Hospital 
for  years  and  years,  who  worked  for  nothing  down  there,  and 
gave  her  whole  life  to  kids.   I  don't  know  that  it  was  she;  I 
have  a  feeling  that  it  was. 

In  any  event,  we  had  some  money  to  get  a  few  extra  things -- 
whatever  was  needed.   We  got  training  materials  and  patient 
education  materials  and  we  started.   The  first  clinic  we 
started  was  way  out  in  the  Brentwood  area,  in  the  eastern 
county,  which  was  almost  entirely  rural  in  those  days. 

Crawford:   Largely  Hispanic? 

Blum:      Not  remarkably  Hispanic.   There  were  people  there  from  Arabia, 
mostly  a  lot  of  American  agricultural  migrants  settling  out. 
It  was  just  all  kinds  of  poor  people.   These  were  people  still 
settling  out  from  the  Dust  Bowl  and  working  in  agriculture. 

We  got  our  referrals,  initially,  mostly  from  a  Catholic 
priest—which  we  thought  was  a  good  idea.   He  was  quite  pleased 
to  send  us  people  that  he  thought  needed  the  services.   The 
three  doctors  who  serviced  our  clinic  were  wonderful.   One  of 
them  was  an  ex-Catholic,  one  of  them  was  a  practicing  Catholic, 
and  one  of  them  was  a  Jew;  they  were  partners.   They  were 
superb  people.  One  or  two  of  them  are  still  left  in  the 
community  on  school  boards  and  city  councils.   They  do 
everything.   They're  people-oriented.   They  were  family 
practitioners,  and  they  had  one  of  these  Sears  &  Roebuck 


206 


Crawford : 
Blum: 


Crawford: 
Blum: 


offices.   Sears  &  Roebuck  had,  at  one  time,  put  out  loan  money 
for  offices  for  doctors  who  would  go  into  truly  rural,  unserved 
areas . 

We  gave  them  the  option—they  could  run  our  clinic  in  their 
office  or  we  would  set  up  a  clinic.   They  thought  it  would  be 
better  in  their  office.   It  would  be  simpler  for  them.   They 
had  their  routine,  their  people,  and  everything. 

They  were  also  doing  well-child  clinics  for  us.   They  were 
true  general  practitioners.   In  fact,  they  ultimately  took  one 
of  the  students  from  the  first  class  here  in  the  medical  school 
at  UCB  who  had  to  do  a  month  of  field  work  of  that  sort  as  the 
students  started  in  the  first  year  of  our  medical  school. 

I  remember  that  their  office  billed  us  for  their  services, 
but  they  had  to  do  it  on  county  forms,  and  I  remember  them 
asking,  "Couldn't  we  skip  the  county  forms?  Why  can't  we  bill 
you  on  our  forms?  You're  setting  the  stage  for  our  staff  to  be 
snooty  about  these  customers  who  come  with  county  forms,  while 
our  private  patients  just  come  in.   We  don't  need  to  set  the 
stage  for  discrimination  in  our  office."  This  was  very 
atypical  for  physicians  in  those  days,  and  we  were  proud  of 
them  for  their  sensitivity. 

To  be  sensitive  in  that  way? 

Yes--their  attitude  of,  "Let's  not  add  any  needless  problems 
for  these  folks;  these  folks  have  got  their  share  of  problems." 
I  thought  that  was  marvelous. 

So,  we  had  a  Catholic  referral  source  —  a  priest  of  a  local 
parish— and  we  had  these  docs,  two  of  whom  were  Catholic.   It 
was  really  a  nice  operation.   It  was  made  clear  by  us  to  our 
nurses  that  if  they  didn't  want  to  work  in  a  birth  control 
clinic,  they  didn't  have  to.   There  were  certain  of  the  nurses 
for  whom  that  was  not  a  happy  prospect. 

Somewhere  about  this  time,  a  man  by  the  name  of  Weingand, 
who  was  the  state  senator  from  Santa  Barbara  County,  heard 
about  this,  and  he  had  introduced  a  bill— this  was  in  Pat 
Brown's  time- -which  said  that  health  departments  had  to  do 
birth  control.   Weingand  was  very  interesting,  and  a  wealthy 
man.   He  and  Ronald  Colman--do  you  remember  that  name? 

Yes,  I  do. 

A  movie  star— were  partners  in  Rancho  San  Ysidro,  just  outside 
of  Santa  Barbara. 


207 


Crawford:   San  Ysidro? 

Blum:      San  Ysidro.   That's  the  one  that  John  F.  Kennedy  and  Jacqueline 
had  their  honeymoon  in. 

Well,  he  introduced  the  bill.   We  weren't  totally  secretive 
about  what  we  were  doing—we  just  didn't  advertise  it--but 
first  thing  I  know,  Weingand  asked  if  I  would  please  come  up 
and  testify  at  a  legislative  hearing  in  Sacramento. 

We  got  to  the  hearing,  and  everybody  was  there:  cameras, 
reporters,  everybody.   There  was  a  Catholic  legislator  on  this 
committee  and  he  didn't  want  the  trouble  of  having  to  vote  yes 
or  no,  so  he  started  out  on  a  clever  tack.  He  said,  "Doctor, 
is  there  anything  in  the  California  state  law  that  you  are 
aware  of  that  would  prevent  a  health  department  from  offering 
birth  control  services?"  Well,  he  certainly  had  me  in  an 
interesting  spot,  since  we  were  doing  it  already  on  a  huge 
scale  all  over  the  county.   I  said  no,  of  course  not. 

Crawford:   Was  the  nature  of  this  investigative? 

Blum:      No,  no,  this  was  not  an  investigation,  this  was  a  hearing  on 
Weingand 's  bill  requiring  all  health  departments  to  provide 
birth  control  services. 


Crawford: 
Blum: 


He  repeated  himself,  and  I  said,  "No,  absolutely  not.   We 
know  that's  the  case.   We  investigated  it  totally."   So,  this 
committee  member  turns  to  the  committee  and  says,  "Mr. 
Chairman,  I  move  we  table  this  bill.   There's  no  point  in  it. 
There's  absolutely  no  reason  we  have  to  deal  with  this  bill 
since  health  departments  can  offer  birth  control  services  now." 
Everybody  on  the  committee  was  so  glad  to  get  rid  of  it,  they 
tabled  it.   That  was  the  end  of  the  bill. 

That  was  in  the  morning  in  Sacramento,  and  at  noon,  the 
Contra  Costa  County  Health  and  Welfare  Federation  was  holding 
its  annual  meeting  of  about  450  guests  and  members  in  Concord 
at  the  Sheraton.   I  was  president  of  that  organization,  and  our 
guest  speaker  was  the  head  of  health  and  welfare  for  Pat  Brown. 
Winslow  Christian  was  a  lawyer,  and  became  a  well  known  judge 
afterwards.   He  was  a  Mormon,  and  a  very  lovely  man.   He 
helicoptered  down,  and  I  drove  like  mad  to  get  back  in  time. 

Luckily  it  was  in  Sacramento. 

I  got  to  Concord,  and  didn't  know  what  else  the  future  held 
because  the  Sacramento  hearings  were  the  first  news  to  most 
people  in  Contra  Costa  that  we  ran  birth  control  clinics. 


208 


Crawford:   Well,  you  weren't  trying  to  keep  them  quiet? 
Blum:      No,  but  we  weren't  making  an  issue  of  it,  either. 
Crawford:   Did  you  anticipate  some  trouble? 

Blum:  Oh,  we  anticipated  plenty  of  trouble,  and  that  was  the  reason 
for  the  white  paper,  and  getting  it  adopted  by  the  Conference 
of  Local  Health  Officers  and  then  by  the  State  Board  of  Health. 

We  sat  down  to  our  meal,  and  Winslow  Christian  said, 
"Doctor,  do  you  have  any  feelings  about  what  1  talk  about?"   I 
said,  "Oh,  no.   We  asked  you  to  bring  what  you  at  the  state 
level  thought  was  the  most  pressing  business  here."  There  were 
some  members  of  the  press  there  too,  of  course.   This  was  a  big 
gathering  of  all  the  elite  Contra  Costa  County  folks.   He  said, 
"Well,  the  governor  and  I  talked  about  this,  and  we  are  going 
to  present  this  statement  about  birth  control  and  family 
planning."  And  it  was  our  white  paper—the  one  that  we  had 
created  in  Contra  Costa  several  years  before.   He  said,  "This 
is  the  governor's  official  position;  this  is  my  position;  and 
this  is  where  we  go  from  here.   This  is  service  we  expect  every 
health  department  to  offer.   We  don't  need  any  new  laws." 

As  an  aside,  people  probably  don't  remember,  but  Pat  Brown 
was  always  a  good  Catholic.   Pat  Brown  even  got  remarried  in 
the  church  just  a  couple  of  years  before  this  happened,  because 
he'd  had  a  civil  marriage  originally.   So  you  know  that  he  was 
a  serious  Catholic  and  making  a  point  of  it.   Here's  his 
minister—the  Secretary  of  Health  and  Welfare— who"  s  a  Mormon 
and  supposedly  more  apt  to  talk  about  procreation  than  how  to 
avoid  it. 

When  I  got  back  to  my  office  about  two-thirty,  every 
newspaper  in  the  country  wanted  to  talk  to  me.   This  was  really 
a  big  deal.   I  called  the  Richmond  Independent  first  because 
that  was  our  lousy,  local,  little  paper— and  it  was  a  lousy 
little  paper.   The  reporter  whose  call  I  was  returning  was  a 
fellow  by  the  name  of  Archinal.  He  was  a  mean  little  cuss,  and 
I'm  sure  if  he's  still  alive,  he  hasn't  improved  any.   He  said, 
"Doctor,  did  you  clear  this  with  the  Archdiocese  in  Oakland?" 
I  responded  that  I'd  never  thought  of  that  because  I'd  never 
worked  for  the  Archdiocese,  I  worked  for  the  people  of  Contra 
Costa  County.   He  was  looking  for  some  vulnerable  point. 

Well,  at  that  point  the  Richmond  Independent  was  already 
out  with  foot-high  headlines:  "Health  Officer  Admits  Operating 
Birth  Control  Clinics."  So  you  can  see  that  we  weren't  wrong 
in  anticipating  trouble.   I  said,  "Why  don't  you  clear  it  with 


209 


Crawford: 
Blum: 


Crawford; 
Blum: 


the  Archdiocese  and  find  out  what  they  have  to  say?   It  would 
be  interesting."   So  he  did. 

This  was  national  news? 

Yes,  and  especially  the  Chronicle,  the  Examiner,  the  Tribune- - 
the  big  local  papers.  We  got  visibility,  to  put  it  mildly,  and 
here's  this  Richmond  Independent  trashing  us. 

The  next  day  there  was  a  full  page  in  the  Richmond 
Independent  on  what  the  Archdiocese  had  to  say  about  it.   We 
read  that  page,  and  it  listed  all  the  sins  that  we  were 
committing.  Well,  I  think  we  knew  them  just  as  well  as  the 
Archbishop  because  we  had  studied  the  ethics  book  from  the  St. 
Louis  Catholic  University  Medical  School,  and  much  of  that  book 
was  on  birth  control.   We  had  studied  it  before  we  wrote  the 
white  paper  and  countered  all  the  issues  that  they  raised,  most 
of  which  were  irrelevant  from  my  standpoint  of  social  justice. 
The  Archbishop  of  the  Oakland  Archdiocese  ended  up  saying,  "The 
Archdiocese  plans  no  action  at  this  time,"  and  that  was  the  end 
of  it. 

Before  many  days  were  over,  health  departments  all  over  the 
country  were  in  the  business.   It  wasn't  bad,  you  see,  but 
there  still  were  a  few  states  that  had  laws  against 
disseminating  birth  control  information. 

Can  we  endorse  programs  abroad  at  this  point? 

Oh,  we  spent  more  money  on  that  than  we  ever  did  internally. 
We  had  been  doing  this  work  all  over  the  world,  but  we  had 
different  eras  of  being  for  or  against  it,  depending  on  who  was 
president  and  who's  singing  the  loudest.   In  this  country  the 
result  to  allow  sale  of  birth  control  devices  started  in  Boston 
and  New  England  years  before,  when  you  couldn't  even  buy 
contraceptive  materials  in  drugstores.   That  was  a  real  late 
development  in  this  country—it  was  mid-century.  Although  the 
ban  on  contraceptives  was  taken  off  the  books  in  most  states 
before  1960,  it  just  wasn't  offered  in  public  agencies.   If  it 
was,  it  was  done  surreptitiously.   So  we  broke  that  taboo  which 
only  discriminated  against  the  poor. 

Then  I  went  on  the  circuit,  I  was  invited  here,  and  invited 
there  to  talk  about  it.   One  of  the  first  places  that  I  was 
invited  to  was  Santa  Barbara  because  Santa  Barbara,  as  well  as 
being  a  strong  Catholic  community,  is  also  a  very  strong  New 
England-Protestant  community  with  summer  homes  of  very,  very 
wealthy  New  Englanders.   There  is  a  regular  Protestant  social 


210 


roster  down  there  in  Santa  Barbara,  and  some  of  these  people 
were  very  pro-family  planning. 

Crawford:   That's  interesting,  because  it's  such  a  conservative  place. 

Blum:      Oh,  yes,  but  not  about  birth  control  for  the  Protestants.   The 
real  wealth  in  that  community  is  the  Eastern  wealth,  old  East 
Coast  wealth,  Protestant  wealth. 

So  I  was  down  there  first  thing.   We  stayed  in  that  San 
Ysidro  Ranch  as  a  guest  of  Senator  Weingand  and  we  were  treated 
like  royalty.   The  first  night  we  were  there,  we  went  to  their 
famous  restaurant  with  big  adobe  walls—it  was  historically 
used  to  keep  the  lemons  cool  when  they  picked  them  on  the 
rancho;  but  now  it's  a  fine  restaurant. 

It  was  where  he  invited  us,  and  we  had  a  beautiful  meal. 
He  said,  "I  should  tell  you  something  about  what  you've  been 
through."  Here  I  thought  I 'd  been  through  it  and  we  had 
figured  all  this  out.   Well,  it  seems  that  he  and  Pat  Brown  and 
his  Health  and  Welfare  director  had  dinner  the  night  before 
those  hearings.   So  I  wasn't  really  in  the  middle  of  putting 
all  this  together  at  all,  I  was  just  a  tool.   [laughter]   They 
had  decided  that  the  thing  to  do  was  to  use  these  hearings  to 
get  an  airing  of  the  issue,  but  irrespective  of  how  they  turned 
out,  they  knew  that  that  new  law  wasn't  required.   Weingand  was 
just  doing  it  to  force  the  issue.   Then,  since  the  Secretary  of 
Health  and  Welfare  was  speaking  in  Contra  Costa  on  the  same 
day,  he  would  trot  out  our  policy,  just  get  it  all  over  at  one 
big  bash.   Moreover,  the  inconclusive  hearings  at  Sacramento 
took  the  edge  off  the  issue  while  the  governor's  statement  at 
the  lunch  in  Contra  Costa  County  got  the  policy  out  with  a 
minimum  of  fanfare. 

Crawford:   This  was  all  rather  elaborately  orchestrated,  then? 

Blum:      Elaborate,  and  I'm  the  thing  being  orchestrated.   [laughter] 
My  wife  and  I  sit,  listening  to  this,  and  you  don't  know 
whether  to  feel  foolish  or  smart,  because  you're  very  clearly 
just  a  pawn,  but  a  useful  one  by  being  the  first  in  the 
business  when  the  risk  was  still  high. 

Crawford:   Well,  they  probably  chose  the  right  man,  then. 

Blum:      Yes.   I  knew  Pat  Brown  fairly  well  and  it  was  he  who  appointed 
me  to  several  statewide  commissions  before  that.   I  hadn't  done 
many  political  things,  so  I  wasn't  startled,  you  know,  but  for 
a  Catholic  to  take  that  kind  of  a  risk  and  to  use  a  Mormon  to 
do  it  is  really  so  damn  subtle.   They  really  killed  the 


211 


opposition  cold,  but  took  the  chance  of  killing  themselves, 
Laudable  governance  at  the  least. 


Crawford:   Well,  he  didn't  worry  about  that, 
admirable. 


I  think  that ' s  rather 


Blum:      I  loved  Pat  Brown,  he  was  all  right.  But  the  net  result  of  all 
of  that,  really,  I  haven't  yet  told  you.  Everything  subsided, 
and  my  board  of  supervisors  is  sitting  there,  aghast.   Four  of 
them  are  Catholics,  the  county  manager  is  a  Catholic,  and  the 
fifth  board  of  supervisors  member  is  in  a  Catholic  district, 
but  isn't  a  Catholic.   So  he's  the  most  vulnerable  of  all.   How 
do  you  like  that  for  a  potentially  stacked  deck? 

The  next  budget  hearing  was  coming  up,  and  this  time  in  the 
budget  we  had  lines  showing  what  the  stuff  was  for.   In  the 
past,  we  really  lumped  like  things  together,  e.g.,  drugs, 
instruments,  personnel  hours—we  didn't  specify  everything  by 
the  purpose  it  was  to  serve.   This  time  they  had  told  us  we  had 
to  specify.   That  was  the  game.   So  if  anything  about  birth 
control  would  show  up  as  such,  they  could  knock  it  out  with  a 
scratch  of  a  pencil. 

I  went  to  the  finance  committee  meeting  of  the  board,  with 
the  Catholic  administrator  who  had  only  two  children  and  didn't 
mean  to  have  any  more.   In  fact,  none  of  the  board  members  did 
either.   [laughs]   But  business  is  business.   They  said  to  me, 
"Doctor,  you  have  to  knock  this  out  —  all  the  birth  control 
items."  And  I  said,  "Look,  you're  the  ones  that  asked  for  the 
itemization."  They  said,  "Yes,  but  we  just  can't  have  this  in 
the  budget."   I  said,  "It  seems  to  me  that  you  had  better  not 
knock  this  out  because  I  have  a  feeling  that  at  least  a 
thousand  people  will  descend  on  the  boardroom  the  day  after  you 
knock  it  out.   You'll  be  lucky  to  ever  go  home.   It  might  be 
five  thousand  people."  These  are  the  realities,  and  if  they 
didn't  understand  these  things,  I  thought  I'd  better  explain 
them. 

They  said,  "Oh,  gosh,  Doctor,  we  treat  you  real  good,  don't 
we?"   It's  a  whole  new  line  of  reasoning.   [laughs]   I  said, 
"Yes,  you're  very  fair,  and  I  have  nothing  to  complain  about 
really.   I  can't  complain  at  all.   You're  a  good  board."  Then 
they  said,  "We're  very  generous,  really,  with  the  health 
department,  aren't  we?"  I  said,  "Well,  I  guess  you  could  say 
that.   You  don't  cut  stuff  out  willy-nilly,  and  so  on,  yes.   We 
don't  ask  you  for  much  fancy  stuff,  but  we  surely  ask  you  for 
things  all  the  time."  The  budget  was  getting  big,  in  spite  of 
our  attempts  to  hold  it  down.   They  said,  "Well,  let's  cut 
these  birth  control  items  out,  and  then  you  do  what  you  damn 


212 


well  please  about  which  categories  you  dip  into  to  do  your 
birth  control  work." 

Crawford:   Call  it  something  else? 

Blum:      Don't  call  it  anything,  just  cut  these  labeled  items  out, 

they'll  disappear,  and  our  budget  could  take  it  by  skimping 
here  and  there.   It  wasn't  that  much--maybe  twenty-five 
thousand  dollars. 

Crawford:   Were  you  still  operating  with  the  Swiss  money? 
Blum:      No,  that  was  just  chicken  feed,  long  since  gone. 
Crawford:   That  had  been  used  to  set  up  the  clinics? 

Blum:      Yes,  that  was  just  to  get  started.   I  think  we  may  have  paid 
that  to  Planned  Parenthood  because  they  had  to  pay  the  salary 
of  their  people  to  come  and  work  with  us.   So  I  said  to  the 
board,  "This  time  we'll  agree  to  knock  it  out,  but  don't  think 
it's  going  to  be  knocked  out  again."   So  the  next  year,  there 
it  was  —  all  the  birth  control  items,  and  nobody  said  a  word. 
It  was  past  history. 

Crawford:  It  was  a  line  that  clearly  defined  it  as  birth  control? 

Blum:  Oh,  yes,  birth  control  supplies. 

Crawford:  Did  it  ever  stop  being  sensitive? 

Blum:  Yes,  that  was  the  end  of  it,  really,  the  end  of  it. 

Crawford:  It  was  publicly  approved  by  even  the  church,  tacitly? 

Blum:      Tacitly,  the  church  hadn't  said,  "God  bless  you,"  but,  yes, 

that  was  all  over.   I'll  come  back  to  the  payoff  for  me  when  I 
get  into  our  move  to  Berkeley. 


Elizabeth  Jolly  and  the  Crippled  Children's  Program 


Blum:      In  the  1960s  the  health  department  hired  Elizabeth  Jolly,  a 

young  M.D.  with  a  degree  in  public  health,  to  run  its  Crippled 
Children's  Program  which  provided  specialist  medical  care  and 
therapy  services  for  children  with  disabilities.   It  enabled 
people  to  get  what  were  very  expensive  services  irrespective  of 
what  they  could  afford.   The  position  involved  arranging  for 


213 


and  then  approving  medical,  surgical,  and  therapist  care. 
Doctors  were  a  major  source  of  referrals,  and  our  own  doctors 
and  the  public  health  nurses  found  cases  in  the  course  of 
visiting  homes,  new  arrivals,  and  PTA  and  other  school-based 
health  activities. 

This  was  obviously  a  very  expensive  program,  but  it  rebuilt 
hips,  overcame  disfiguring  head  and  limb  and  internal  organ 
abnormalities.   It  also  provided  ongoing  clinics  staffed  by  the 
best  Bay  Area  specialists  for  kids  with  heart  and  other  long- 
term  serious  diseases  and  congenital  defects.   Dr.  Jolly 
inherited  the  program  from  a  fine  public  health-trained 
pediatrician  who  remained  full-time  with  Maternal  and  Child 
Health,  since  the  child  population  was  literally  doubling  in  a 
decade.   At  the  end  of  her  first  week  in  the  Crippled 
Children's  Services  (CCS),  she  made  some  interesting 
observations.   She  asked  me  to  come  by  and  look  at  the  caseload 
with  her.   She  took  the  file  card  for  each  case  (this  was 
decades  before  computers)  and  put  them  in  three  stacks.   One 
was  about  four  inches  high,  one  about  two,  and  the  last  one 
about  one  inch  high.   She  explained  that  these  were  sorted  by 
whether  the  case  was  almost  certainly  genetic  in  origin,  likely 
but  not  certainly  genetic,  and  clearly  not  genetic,  such  as 
trauma,  burns,  poisoning.   She  asked  me  to  guess  which  stack 
was  which.   I  only  remember  that  I  was  totally  wrong  and  that 
the  big  stack  was  genetic  and  the  smallest  one  was  not  genetic. 

On  the  genetic  stack  she  then  showed  me  several  families 
that  had  more  than  one  child  with  the  same  condition,  some 
truly  grim,  such  as  hereditary  young  male  adult  blindness. 

This  set  us  off  on  quite  an  intellectual  spin,  particularly 
since  we  were  already  providing  birth  control  advice  and 
services.   Some  of  the  families  with  multiple  cases  were 
tragic.   One  mother  contemplated  suicide  because  of  her 
inadvertent  role  in  transmitting  a  male-only  blindness  which 
her  father,  a  physician,  developed  after  she  was  born.   Her 
oldest  son  just  got  the  diagnosis,  and  her  two  younger  boys 
also  faced  early  blindness. 

Dr.  Jolly  had  been  interested  in  things  genetic,  as  so  many 
people  are,  but  this  soon  became  her  life's  work,  not  just  a 
concern.   She  found  a  keen  human  geneticist,  Curt  Stern,  at  UCB 
who  had  not  been  involved  in  doing  anything  about  it  other  than 
studying  the  various  diseases  caused  by  genetic  disorders,  and 
the  nature  and  extent  of  their  hereditary  transmission.   She 
took  him  the  records  of  her  families  and  they  worked  out  what 
options  might  be  offered  in  each  case.   In  some,  basic  birth 
control  was  the  answer,  and  applicable  along  the  family  tree. 


214 


In  others,  this  was  irrelevant  or  too  late.   But  advice  to 
involved  persons  and  potentially  involved  family  members  could 
be  life-saving  where  prompt  medical  diagnosis  and  care  could 
hold  the  disease,  or  where  avoidance  of  certain  exposures  could 
minimize  or  delay  damage  from  inherited  disease. 

Thus  began  the  first  formal  genetic  counseling  program  that 
any  of  us  had  ever  heard  of.   In  getting  grounded  we  used  a 
family  tree  approach  to  get  necessary  information  for  the 
counseling  and  to  begin  the  search  for  other  persons  who  might 
be  hereditarily  involved  in  order  to  find  them  long  before 
there  would  be  any  evidence  of  the  familial  disease.   In  some 
cases  it  meant  watchful  waiting;  in  others,  the  need  to  prevent 
further  offspring;  in  others,  blood  testing. 

Nurses  helped  the  involved  families  to  fill  out  the  tree, 
who  was  on  it,  and  what  had  happened  to  them  to  date.   Families 
loved  this,  contacted  long-abandoned  relatives,  and  got 
information  that  varied  from  critical  firm  diagnoses  to  wild 
guesses.   Sometimes  it  would  be  a  year  or  more  later  that  a 
family  would  call  in  to  say  that  so-and-so,  who  was  related  in 
certain  ways,  had  developed  a  clear-cut  diagnosis  that  had 
genetic  implications  or  had  confirmed  the  presence  of  suspected 
familial  disease. 

Looking  at  a  family  history  was  a  favorite  way  for  our 
public  health  nurses  to  get  acquainted  with  a  family  even  when 
the  introduction  to  the  family  had  no  relationship  to  genetic 
concerns.   The  nurses  asked  for  the  freedom  to  use  this  mode  of 
introducing  themselves  and  many  did  so  for  any  but  the  most 
inconsequential  family  contacts. 

Someone  heard  about  this  activity,  I  suspect  from  the 
papers  we  published,1  and  we  soon  made  the  newspapers.   We 
started  getting  family  trees  from  families  in  other  parts  of 
the  U.S.  and  even  from  other  countries,  with  requests  for 
advice  about  one  or  another  aspect  of  a  problem.   Much  of  it, 
of  course,  was  about  what  to  expect  from  having  children  under 
various  disease-shadowed  circumstances. 


'Jolly,  E.,  H.L.  Blum,  G.  Keyes,  and  G.  Smith.   "Experience  of  Public 
Health  Nurses  in  Obtaining  Family  Pedigrees."  Public  Health  Reports  80:1, 
41-46,  January  1965.   Jolly,  E.  and  H.L.  Blum.   "Genetic  Counseling—A 
Health  Department  Service  to  Physicians."  California  Medicine  103:5,  330- 
333,  November  1965.   Jolly,  E.  and  H.L.  Blum.   "The  Role  of  Public  Health 
in  Genetic  Counseling."  American  Journal  of  Public  Health  55:2,  186-190, 
February  1966. 


215 


When  I  came  to  UCB  I  brought  Betty  Jolly  with  me,  and  she 
also  obtained  a  nontenured  faculty  slot  to  teach  public  health 
genetics,  and  continue  her  research  on  genetic  diseases, 
transmission,  and  genetic  counseling.   These  were  the  first 
courses  on  genetics  at  the  UCB  School  of  Public  Health. 

One  morning  Dr.  Jolly  awoke  with  a  painful  abdomen,  and  in 
a  few  days  was  diagnosed  as  having  far  advanced  gastric 
carcinoma  and  was  dead  in  a  year.   She  was  not  only  a  handsome 
woman  but  one  with  a  lovely  personality,  had  a  husband  with 
comparable  qualities,  and  two  lovely  teenaged  daughters.   She 
had  a  youngish  mother  and  a  physician  sister  who  was  a  county 
health  officer  in  California. 

When  it  came  time  to  acknowledge  her  life  and  death,  the 
family  descended  on  me  to  say  what  had  to  be  said  about  her 
life  and  her  accomplishments  at  a  family-only  ceremony.   I  had 
never  undertaken  such  a  task,  knew  her  family  hardly  at  all, 
and  tried  to  avoid  it.   But  her  family  insisted  that  I 
undoubtedly  knew  more  about  her  work  life  than  anyone  else  and 
that  was  what  they  knew  so  little  about,  and  what  they  wanted 
to  know  more  about . 

I  started  out,  broke  down,  had  plenty  of  company,  started 
again,  we  broke  down  again,  and  that's  pretty  much  how  it  went 
for  two  hours  when  it  suddenly  seemed  that  we  had  done  the  job 
and  it  was  time  to  say  goodbye  to  Betty  and  to  one  another.   We 
all  hugged  and  parted. 


Training  Peace  Corps  Volunteers:  1964  f# 


Crawford: 


Blum: 


Crawford; 
Blum: 


There  are  some  consultancies  in  the  1960s, 
did  Peace  Corps  work  in  '64? 


For  example,  you 


Oh,  that  was  just  a  small  thing,  but  again,  really  reaffirming 
my  notions  about  what  we  were  talking  about.   We  were  training 
Peace  Corps  workers  in  the  Contra  Costa  County  Health 
Department  in  some  of  the  basics  of  sanitation. 

To  go  out  into  the  field? 

Go  out  into  the  world,  you  know,  a  world  with  nothing.   We  had 
our  own  little  disaster  manual—we'd  give  this  to  them,  and 
explain  how  to  clean  oil  tanks,  purify  water,  protect  food,  how 
to  do  this,  how  to  do  that.   Chances  were  they  would  never  get 
the  necessary  modern  equipment,  but  we  had  prepared  different 


216 


simple  methods  of  doing  all  sorts  of  health-related  tasks,  even 
tables  about  which  kinds  of  drugs  to  use  for  what  indications 
if  you  were  not  a  doctor.   It  was  all  do-able,  workable;  we 
created  this  for  disaster  preparedness,  and  had  a  good  time 
doing  it.   Even  a  manual  on  toxics—the  first  one,  I  guess 
anywhere.   It  was  nice  to  have  someone  to  use  it  on,  as  we 
never  had  a  disaster  of  the  dimension  that  Peace  Corps  workers 
were  going  to  face  routinely. 

Crawford:   In  Contra  Costa? 

Blum:      Yes,  we  had  prepared  it  for  an  ultimate  disaster  in  Contra 

Costa--in  the  U.S.A.,  or  anywhere  else.   The  toxics  manual  was 
used  at  UCSF.   The  Peace  Corps  people  were  going  to  areas  that 
were  permanent  disasters,  by  and  large.   So  maybe  they  would 
use  it;  we  trained  them  how  to  protect  or  clean  things,  how  to 
fight  various  problems. 

Crawford:   How  did  you  get  this  association? 

Blum:      I  don't  know,  I  just  volunteered,  I  guess. 

Crawford:   In  other  words,  the  Peace  Corps  might  have  written  health 
departments  and  asked  for  this  training? 

Blum:      Yes.   However,  I  remember  that  Len  Duhl  was  Sargent  Shriver's 
health  advisor— Shriver,  the  head  of  the  Peace  Corps  —  and  Len 
was  very  close  to  the  Kennedys.   He  might  have  had  something  to 
do  with  our  involvement . 

The  Peace  Corps  worked  for  two-year  terms,  typically— and 
by  the  third  year,  all  the  Peace  Corps  people  who  had  returned 
after  their  two  years  were  invited  by  Shriver  to  the  State 
Department  for  a  big  week.   They  weren't  very  fond  of  Shriver, 
which  was  kind  of  funny  because  he  kept  the  CIA  out  of  their 
ranks  and  really  seemed  to  be  quite  involved  in  their  well- 
being.   I  guess  it  was  a  generic  distrust  of  political  people 
by  folks  who  were  prepared  to  put  their  lives  at  risk. 

II 

Blum:      The  Peace  Corps  also  got  one  hundred  people  like  me  to  come  and 
sit  down  with  these  folks  for  a  couple  of  days  and  consider  how 
these  returnees,  who  were  from  every  walk  of  life,  could  put 
what  they  had  learned  overseas  to  use  at  home.   A  marvelous 
program.   I  loved  what  I  saw  because  here  were  people  of  all 
races  throwing  their  arms  around  one  another.   They  hadn't  seen 
one  other  since  Africa,  Asia,  wherever;  and  here  they  are  just 
obviously  really  entranced  to  see  one  another. 


217 


Then  we  sat  down,  and  the  advisors  kept  rotating  to  groups 
of  twenty  returnees.   Every  two  hours  or  so  I'd  go  to  another 
group.   Their  theme  was,  "What  can  we  do  here  with  what  we 
learned  overseas?"   It  was  going  to  be  damned  little,  but  many 
of  them  intended  to  try,  and  some  ultimately  went  back  overseas 
because  our  ways  of  doing  things  were  pretty  entrenched  and  not 
necessarily  burdened  with  the  human  touch. 

The  miscue  of  the  first  half  really  was  the  opening  address 
by  Shriver,  who  was  on  the  edge  of  getting  the  business  from 
the  attendees.   But  then  Earl  Warren  spoke  for  an  hour,  and 
they  just  went  crazy.   He  was  great.   Then  Hubert  Humphrey 
spoke,  and  he  spoke  too  much.   I  remember  that  he  didn't  play 
the  hero,  and  ultimately  he  came  across  well.   He  said,  "If  you 
don't  like  what  you  see  in  Washington,  remember  that's  no  more 
than  a  mirror  image  of  you  folks  back  home.   If  you  didn't  want 
what  you  don't  like,  you  wouldn't  have  it."  That  was  pretty 
insightful. 

Then  Sister  Jacqueline  from  Webster  College  —  the  one  I 
spoke  of  a  while  ago—gave  the  closing  address.   She  happened 
to  be  a  very  beautiful  woman.   She  was  still  in  her  habit,  and 
I  had  ridden  to  this  affair  in  a  taxi  with  her  from  the  hotel 
where  we  were  staying,  at  the  Dupont  Circle.   I  had  always  been 
a  bit  patronizing,  I  think,  to  nuns,  and  there  she  was,  in  her 
habit.   I  asked  her  something  about  Webster  Falls,  which  she 
had  made  very  famous  as  a  little  Catholic  university.   As  a 
matter  of  fact,  she  started  to  explain  to  those  of  us  in  the 
cab  that  she  was  free  to  leave  now;  she  had  done  her  job  there. 
She  had  left  a  new,  non-Catholic  board  of  regents  in  charge  of 
this  Catholic  school  where  she  had  been  the  boss.   Webster 
College  now  had  a  board  of  regents— and  the  chairman  was  also 
the  chairman  of  MIT:  I  can't  remember  whom- -a  nice  Jewish  name. 

I  was  sitting  up  front  of  the  taxi,  these  three  women  were 
in  back— and  I  said,  "Sister,  what  in  the  world  are  you  trying 
to  tell  us?  Why  is  it  so  important  for  a  Catholic  university 
to  have  an  independent  board  of  regents  with  no  Catholics  on 
it?"   She  said,  "How  would  you  like  to  go  to  a  university  run 
by  Standard  Oil?"   I  thought,  "Wow,  this  lady  is  really 
something  else,  again."  You  don't  talk  like  that  as  head  of  a 
Catholic  school. 

She  was  last  on  the  program  that  day.   She  made  it  clear 
that  she  was  a  woman;  the  three  speakers  preceding  were  all 
famous  men.   She  said  she  was  an  educator,  and  that  she  worked 
for  God  through  the  Church  as  an  institution,  that  she  believed 
in  the  words  of  God  and  the  works  of  God,  which  had  to  be 
taking  place  here  and  now— not  in  the  future.   I  suspect  many 


218 


people  in  the  Peace  Corps,  particularly,  were  prepared  to  hate 
a  Catholic  nun,  but  not  this  one;  everybody  loved  her.   For 
this  person  to  steal  the  show  from  Earl  Warren,  and  Humphrey! 
She  left  a  message:  "You  folks  went  out  there  and  did,  here  and 
now,  the  Good  Lord's  work.   Now  is  when  it  has  to  be  done. 
It's  not  going  to  be  done  in  the  hereafter."   She  was  a 
liberation  theologist  at  Webster  College. 

Crawford:   You  have  to  hand  it  to  Shriver  or  whoever  found  her. 

Blum:      Well,  yes,  I  think  Len  Duhl  got  her.   He  was  advising  Shriver. 
I  don't  know  that  he  thought  she  would  steal  the  show,  but  she 
surely  was  the  most  important  person  for  the  returnees.   She 
was  reaffirming  what  the  Peace  Corps  was  all  about.   Then  we 
went  back  to  our  groups.   People  spent  the  next  couple  of  days 
trying  to  figure  out  how  they  could  use  what  they  had  learned 
about  working  with  strangers  on  their  terms  in  their  homelands 
to  improve  life.   Also,  you  don't  join  the  Peace  Corps  because 
you  think  everything's  perfect  here.   It  was  really  one  of  the 
highlights  of  my  life.   In  fact,  I  was  on  a  high  for  several 
weeks  reliving  the  wonderful  feelings  I  got  from  the  returnees. 

Crawford:   And  did  you  work  something  out  that  was  positive? 

Blum:      Not  specifically,  but  I  don't  think  too  many  people  left 

feeling  that  their  life  was  wasted  or  that  their  Peace  Corps 
experiences  were  useless.   We  see  them  coming  through  here  all 
the  time  at  the  School  of  Public  Health,  School  of  Social  Work, 
ethnic  studies,  planning,  anthropology,  sociology,  and  so  on. 

Those  were  experiences  that  reaffirmed  the  relevance  of 
taking  care  of  human  beings  through  more  than  medical  care,  and 
helping  people  to  help  themselves  as  a  community.   Medical  care 
is  just  a  small,  little  piece  of  it;  this  is  the  big  stuff,  and 
yet  it's  health.   Some  of  these  streams  have  run  all  through  my 
life  and  reaffirm  my  beliefs  about  democracy  and  social 
justice.   I've  never  changed.   The  same  theme  is  still  in  my 
mind.   I  suspect  that's  sort  of  narrow-minded.   Maybe  also  I'm 
not  bright  enough  to  think  of  anything  else. 


Other  Streams;  Creating  Air  Pollution  Control  Legislation 
(1955)  and  the  John  F.  Kennedy  University  (1964);  the  Orinda 
Vision  Study  (1959) 


Blum:      There  was  another  aspect  of  the  environment  that  we  played  a 
role  in--air  pollution  control.   That  was  very  fascinating;  I 


219 


had  an  opportunity  to  work  from  scratch  on  that.   I  was  invited 
to  a  Bay  Area  Council  meeting- -it  was  at  the  Cow  Palace  or  some 
such  place—with  all  the  big  business  people  of  the  Bay  Area. 
I  was  sitting  at  a  guest  table,  and  they  were  speaking  against 
having  any  government  intervention  on  air  pollution.   They 
dredged  up  this  big  old  chestnut:  "We  will  do  it  voluntarily. 
Look  around  the  room—we  control  the  world.   We'll  do  it 
voluntarily.   We  don't  need  government  screwing  this  up." 

I  listened  to  that  for  a  while,  and  got  to  the  point  where 
I  thought,  "Well,  I'll  just  inform  them  about  what  they're 
talking  about."   I  stood  up— and  there  was  no  way  they  were  not 
going  to  have  me  stand  up  since  I  was  a  guest— and  I  said,  "I 
want  to  comment  on  your  posture.   You're  taking  a  very  peculiar 
and,  I  would  say,  unfortunate  position  in  favor  of  voluntary 
control. 


"In  the  first  place,  you  are  now  telling  everybody  that  you 
caused  the  air  pollution,  right?  How  can  you  control  it  if  you 
don't  cause  it?  That's  an  interesting  point  I'm  not  sure  you 
want  to  make.   The  next  thing  is  that  you  don't  produce  it— you 
don't  seem  to  understand  that.   Sixty-five  percent  of  the  air 
pollution  in  this  region  is  caused  by  automobiles.   There  isn't 
anybody  in  this  room  can  do  a  damn  thing  about  it,  as  they 
stand,  voluntarily.   So— one— you  admit  to  being  the  guilty 
party,  and— two— you  offer  to  fix  it,  and  of  course  it  can't  be 
fixed  the  way  you're  going  to  go  about  it.   So,  you're  going  to 
look  very  interesting  to  the  populace.   You're  going  to  look 
like  criminals  for  causing  all  the  pollution  and  like  fools 
because  you  can't  fix  it." 

Crawford:   This  was  before  the  Air  Pollution  Control  Board? 

Blum:      Before  there  ever  existed  any  such  thing.   There  was  no 

applause  or  response  to  these  comments;  I  guess  they  were  sort 
of  insulting.   I  got  back  to  my  office,  and  there  was  a  phone 
call  from  an  engineer  named  Bill  O'Connell  whom  I  had  known  for 
a  long  time— shrewd,  brilliant  man— and  he  said,  "The  oil 
companies  in  Contra  Costa  County  would  like  to  have  me  sit  down 
with  you  and  develop  an  air  pollution  control  law."  The  same 
outfit  that  just  got  through  yammering  about  voluntary  control. 
It  finally  dawned  on  them  that  they  would  be  blamed  for  all  of 
it,  and  they  couldn't  do  anything  about  it.   So  we  sat  down  and 
wrote  out  what  became  the  Bay  Area  Air  Pollution  Control 
District  Law  in  the  next  few  days. 

It  was  an  interesting  experience  for  me  to  work  with  a 
superb  engineer,  and  a  superb  lobbyist,  and  superb  politician, 
who  wasn't  about  to  have  the  thing  fail,  even  though  he  was 


220 


Crawford: 
Blum: 


hired  by  each  of  the  four  major  oil  companies  in  the  state,  and 
then  by  the  Contra  Costa  board  of  supervisors.  In  a  few  hours, 
we  had  written  out  the  basic  law,  which  is  the  law  today. 

He  was  tremendous.   He  figured  out  that  each  of  the 
counties  ought  to  have  one  supervisor  as  a  member  on  the  board 
--and  each  set  of  cities  in  a  county  should  have  one  vote  on 
the  board,  too.  That  would  keep  them  all  happy,  and  establish 
limits.  These  elected  officials  would  make  up  the  Bay  Area  Air 
Pollution  Control  Board.   Then  he  picked  out  the  individuals 
from  each  county  who  ought  to  sit  on  its  governing  board.   He 
started  out  with  San  Mateo  County,  and  picked  the  chairman  of 
their  board  of  supervisors—that  was  all  right,  because  it 
happens  that  Martin  Poss  owned  a  huge  nursery—he  raised 
carnations  —  and  every  smoggy  day  he  lost  a  fortune. 

He  had  very  stringent  standards? 

Bill  O'Connell  had  super  standards.   And  he  found  an 
industrialist— whose  name  I  don't  remember— a  retired 
industrialist  from  Marin  County  who  had  other  reasons  for 
wanting  air  pollution  controlled,  who  was  on  a  city  council 
there.   He  got  the  chairman  of  the  board  of  Alameda  County.   I 
knew  him  from  when  he  used  to  take  tickets  on  the  Key  Line 
ferryboats.   He  was  a  jovial,  red-headed  Irishman  with  a  great 
accent— he  was  on  the  board. 


Crawford: 
Blum: 


So  we  went  through  each  county  selecting  by  name  the  board 
member  and  the  city  council  member.   And  he  lobbied  so  cleverly 
that  each  of  these  persons  was  selected  by  their  group  as  Bill 
had  intended.   Masterful,  unbelievable. 

Then  he  said,  "We  need  a  technical  advisory  board.   They 
are  going  to  have  to  develop  the  rules  and  standards."  He's 
picking  out  all  the  people,  and  he  says,  "You  be  the  health 
person  on  it,  and  I'll  be  the  engineer."  He  picked  a  wonderful 
architect  from  San  Francisco  who's  still  very  active  in 
community  affairs.   He  picked  a  wonderful  planner  as  well. 
Again  he  lobbied  the  yet-to-be  governing  board  members  and  got 
us  all  appointed  to  the  technical  advisory  group. 

Do  you  have  names? 

No,  I  can't  think  of  many,  but  Livingston  was  the  planner. 
These  were  just  fabulous  people.   You  couldn't  get  better 
people. 

The  thing  went  right  through  the  state  legislature  so  fast 
it  makes  your  head  swim.   We  left  out  counties  that  didn't  want 


221 


to  play  ball  by  giving  them  time  to  join  later  and  when  it 
became  imperative  they  cooperate  —  all  the  ways  of  getting 
around  negative  votes.   With  the  four  major  oil  companies  for 
it,  let  me  tell  you,  it  wasn't  much  of  a  deal  to  get  it  through 
the  legislature—and  there  we  had  it. 

In  any  event,  the  very  first  meeting  we  had,  Goyak  from 
Contra  Costa  got  up  and  said,  "We  shouldn't  make  the  garbage 
operators  stop  burning."  Contra  Costa  was  full  of  garbage 
dumps  which  burned  the  year  around.   It  turned  out  he  was  the 
garbage  interests'  point  man,  so  it  started  out  looking  bad  for 
the  district. 

Then  this  wonderful  Irishman  from  Alameda  County  got  up, 
and  he  started  a  long  speech  about  pioneers  coming  across  the 
plains,  and  I  thought,  "Oh  my,  oh  my.   He  should  have  stayed 
with  ticket  taking.   This  is  bad." 

Then- -it ' s  just  really  wonderful  how  some  of  these 
uneducated  people  think—he  said,  "What  do  you  suppose  the 
first  thing  these  folks  did  when  they  got  to  California?  They 
set  up  state  government  so  they  could  control  all  the  messes 
that  they  found."  He  said,  "I'm  suggesting  that  we're  in 
exactly  in  the  same  position.   We've  got  a  new  mess.   This  air 
pollution  is  burning  everybody's  eyes."  This  man,  it  seems, 
was  very  pro-real  estate,  and  they  didn't  like  smog. 

So  the  whole  thrust  of  his  speech  was  history  and  cops  and 
robbers,  and  that  the  first  thing  we  did  was  to  have 
government,  and  this  could  be  no  exception.   It  really  got  off 
to  a  great  go,  and  the  whole  board  worked  from  that  day  on. 

I  remember  when  we  held  our  first  organizing  meeting.   I 
don't  member  how  we  arranged  it,  but  Poss  was  the  chairman  of 
the  board,  just  like  we'd  figured.   We're  sitting  at  the  Top  of 
the  Mark  Hopkins— Bill  O'Connell  and  I  are  sitting  right 
alongside  of  a  bunch  of  newspapermen- -and  Martin  Poss  accepts 
the  chairmanship,  and  he  says,  "Well,  we  do  need  a  technical 
advisory  committee."  He  reaches  into  his  coat  pocket  and  pulls 
out  a  three-by-five  card  and  he  reads  off  all  the  names,  and 
the  newspaper  guys  are  looking  at  one  another  and  they're 
saying,  "How  can  he  have  that  list  with  all  those  names  on  it? 
How  did  he  know  he  was  going  to  be  chairman;  that  just 
happened."   [laughter] 

So  there  was  a  technical  advisory  board.   We  met  over  the 
years  at  least  once  a  month  or  more,  and  I  was  always  having  to 
support  Bill  O'Connell.   Everybody  on  the  technical  advisory 
board  knew  that  he  was  the  ultimate  politician,  that  he  was  the 


222 


rascal  that  put  us  all  together,  and  although  they  didn't  have 
any  reason  to  be  against  him,  they  didn't  trust  him,  because  he 
was  such  an  effective  politician. 

So  if  he  would  come  up  with  a  technical  recommendation, 
they  would  automatically  set  it  aside.   He  was  usually  right, 
but  it  was  interesting  that  despite  his  role,  which  had  been  so 
astute  about  creating  what  is  a  remarkably  successful 
operation,  he  still  was  not  trusted  by  the  technical  people. 
Here  he  is,  amongst  his  peers  in  the  technology  advisory  board, 
and  they  don't  trust  Bill  O'Connell.   It's  really  kind  of 
funny.   He  saw  that;  he  always  got  a  kick  out  of  that;  but  I 
was  defending  him  all  the  time.   I  remembered  what  he  went 
through,  and  I  thought  he'd  done  a  wonderful  job;  I  never  could 
have  done  it. 

Crawford:   And  that  legislation  is  still  in  place? 

Blum:       It  is.   Yes,  the  Bay  Area  Air  Pollution  Control  District  is  the 
same  district,  set  up  by  an  engineer  to  do  exactly  what  he 
wants  it  to  do  for  some  very  special  interests,  and  he  does  it 
right  —  and  beautifully,  and  inexpensively. 

Crawford:   That  must  have  been  pretty  progressive  for  the  times.   Did  you 
get  called  on  that? 

Blum:      No,  I  don't  think  I  was  even  perceived  as  an  actor.   I  made  my 
spiel  in  the  right  place  on  the  right  day;  the  oil  companies 
produced  Bill  O'Connell,  and  the  job  was  done. 

Crawford:   It's  a  real  success  story. 

Blum:       It  was  taken  for  granted  I  would  be  on  the  technical  advisory 
committee.   I  was  at  least  as  alert  as  any  other  health 
officer.   In  fact,  being  a  chemist  originally,  I  might  know 
what  we  were  talking  about.   So  that  was  kind  of  a  fun 
diversion.   I  loved  the  Contra  Costa  job  that  made  this  and  so 
many  other  things  possible  for  me. 

Crawford:   Your  stock  must  have  been  very  high  with  the  funding 
organizations. 

Blum:       I  think  it  was  with  various  nongovernmental  organizations.   I 
think  it  was,  but  all  it  required  was  that  you  were  doing 
something  that  was  tangible  and  needed. 

Crawford:   Were  there  such  programs  elsewhere? 


223 


Blum:      There  were  in  some  counties  and  not  in  others.   Alameda  County 
Health  Department  had  its  bright  spots.   It  was  a  real  pusher- 
conservative  in  some  ways  because  they  wanted  to  be  big  and 
they  absorbed  everything  they  could,  which  was  kind  of  tragic 
because  they  couldn't  get  away  with  it.   We  didn't  want  to  be 
big,  so  we  weren't,  but  we  got  the  programs  going  even  if  they 
weren't  in  our  department.   We  had  a  much  better  school  health 
program  than  they  had,  much  better  mental  health—all  kinds  of 
things --without  us  owning  any  of  it. 

Let  me  go  into  one  more  thing:  I  was  on  the  original  board 
that  set  up  the  John  F.  Kennedy  University  in  the  early  1960s, 
and  I've  been  bumping  into  them  again  recently.   It's 
interesting  how  these  things  circle  around. 

Crawford:   Is  that  what  you  call  another  stream? 

Blum:      Yes.   And  this  was  how  we  could  get  something  indigenous  into 
the  county  that  would  teach  mental  health,  teach  this,  teach 
that  —  all  sorts  of  health  and  social  justice  things.   Harry 
Morrison,  who  used  to  teach  administration  at  St.  Mary's,  had 
become  a  banker,  and  all  of  a  sudden,  he  was  well-to-do.   His 
wife  is  still  alive,  I  understand,  and  still  on  the  JFK  board. 
He  got  the  idea  of  setting  up  the  university,  and  decided  on 
the  name  J.  F.  Kennedy  because,  amongst  other  things,  he 
thought  we  would  get  big  money  from  big  folks,  which  was  wrong 
--we  never  got  a  single  dime  from  that  crowd. 

He  and  I  had  been  opponents  forever;  he  represented  the 
taxpayers'  association,  and  every  time  our  budget  came  in,  it 
was  always  growing  as  the  county  grew.   He  was  the 
representative,  the  spokesperson,  for  the  "poor"  taxpayers,  and 
what  is  this  health  department  doing?   It  has  gone  crazy.   So 
Harry  and  I  were  always  tangling  in  front  of  the  board  of 
supervisors.   He'd  give  them  this  big  spiel--he  was  kind  of  a 
bombastic  character,  but  not  a  fool--then  afterwards,  he'd  put 
on  a  big  smile  and  take  me  out  to  lunch  or  something.   Business 
is  business.   He  worked  for  the  taxpayers  association  which,  of 
course,  is  paid  for  by  large  taxpayers. 

Harry  got  the  idea  of  setting  up  this  university,  and  he 
came  over  to  see  me  about  it.   We  weren't  the  best  of  buddies, 
but  we  weren't  enemies.   He  said,  "Why  don't  you  sit  on  the 
board  and  maybe  take  a  hand  at  shaping  the  health  part  of  this 
thing?  Here's  what  this  university  is  about:  in  the  first 
place,  anybody  can  come  in  who  wants  to- -there  is  no  such  thing 
as  prerequisites.   Many  people  who  have  bad  high  school 
records,  bad  college  records  —  if  they  want  to  try  here,  they 
can.   If  they  can't  do  it,  they  will  leave."   I  loved  that. 


224 


Second  paragraph  was  even  better—and  this  from  a  banker. 
"We  are  living  in  a  new  world.   This  world  is  one  world,  and 
yet  we  don't  know  about  other  religions,  other  cultures  in  this 
world  and  in  our  country.   We  don't  even  care.   That's  got  to 
stop.   We're  just  going  to  be  in  endless  wars  and  stupidity. 
So  every  student  has  to  take  a  year's  worth  of  courses  on 
religion  and  culture  before  they  graduate,  so  they  feel  that 
there  are  other  people  in  this  world."   So  I  said,  "Harry, 
you've  got  something,"  and  I  signed  up.   It  was  just  before  I 
came  to  UC  Berkeley. 

He  got  the  head  of  the  county  library,  one  of  those  superb 
people  who  came  out  of  Louisiana,  where  she  hauled  her  books 
around  through  all  the  swamps  on  a  boat.   She  was  a  real 
operator,  a  tremendous  librarian—set  up  all  the  good  libraries 
in  Contra  Costa.   The  county  wouldn't  pay  for  them,  so  she  got 
the  neighborhoods  to  do  it. 

Crawford:   Public  libraries? 

Blum:      Yes.   First  class.   And  then  Harry  got  the  county  assessor  to 
join.   You  say,  "Why  would  that  be?"  Well,  to  establish  a 
university  in  the  state  of  California,  at  that  time,  you  had  to 
have  at  least  thirty-two  thousand  dollars  worth  of  assessed 
property—assessed  evaluation— that  was  the  criteria  for 
universities  in  California.   We  had  gotten  as  a  gift  an 
abandoned  undertaking  parlor.   We  got  the  assessor  to  assess  it 
for  thirty-two  thousand  dollars.   [laughter]   It  was  a  big 
funeral  parlor  in  Martinez  which  was  used  by  JFK  for  ten  years 
as  its  headquarters. 

So  here  was  the  assessor;  then  we  had  the  county 
superintendent  of  schools  office— the  assistant  superintendent, 
actually— giving  it  their  blessing,  the  county  superintendent 
of  schools  office  can  be  very  powerful,  especially  in  a 
negative  way. 

Harry  gathered  up  some  folks  from  industry  like  DuPont  and 
others  who  would  help  set  up  the  chemistry  department  and  give 
it  some  status.   He  got  some  good  lawyers  to  set  up  a  law 
school  and  some  psychologists  —  and  that's  a  big  school  there 
now,  the  psychology  department.   The  reason  I  am  thinking  about 
it  is  that  I  was  invited  to  give  a  lecture  there  the  other  day. 
They  have  now  moved  to  Orinda.   The  man  who  headed  up  the  San 
Francisco  Foundation,  for  which  I  worked  off  and  on  as  a 
consultant,  was  the  first  full-time  president  out  there. 

Crawford:   Who  was  that? 


225 


Blum:      Bob  Fisher.   So,  all  of  a  sudden,  JFK  kind  of  looms  large  in  my 
head  again  when  I  was  asked  to  give  a  class.   It  was  a  fun 
class.   It  was  psychology—a  graduate  psychology  course—and 
the  students  were  older  people,  not  kids.  They're  using 
classrooms  in  one  of  the  grammar  school  campuses  which  they 
have  as  a  gift  from  Orinda.   Harry  was  a  devil—Harry  Morrison, 
the  guy  that  started  all  this— had  to  get  the  accreditation  for 
the  university,  so  he  borrowed  it  from  St.  Mary's,  where  he  was 
a  professor.   They  agreed  to  the  use  of  it.   They  were  an 
umbrella  for  JFK. 

Crawford:   They  can  do  that? 

Blum:      Oh,  they  do  all  sorts  of  things.   He  needed  a  library,  so  the 
librarian  Bertha  Helium  contributed  thousands  of  discards,  but 
that  wasn't  enough.   If  you  were  accredited,  you  could  get  a 
free  library- -many  thousands  of  volumes.   But  you  couldn't  get 
the  accreditation  without  the  library;  on  the  other  hand,  you 
couldn't  get  the  library  without  accreditation.   So,  one  day,  I 
came  to  a  board  meeting  in  the  mortuary,  and  here's  Harry  and 
two  other  men  shaking  hands,  and  one  of  them  is  the 
accreditation  guy,  and  the  other  is  the  library  guy— he's  got 
them  to  sign  on  at  the  same  moment. 

Crawford:   [laughter]   This  is  a  real  mover. 

fi 
Crawford:   It  sounds  as  if  whatever  was  going  on,  you  were  a  part  of  it. 

Blum:      Sometimes,  yes,  that  was  the  fun  of  Contra  Costa.   I  remember 

Harry  Morrison  and  I  going  to  the  University  of  the  Pacific— in 
those  days  it  was  the  College  of  the  Pacific— and  a  former 
president  of  the  student  body  at  UC  Berkeley  was  the  president 
there.   We  went  to  ask  him  how  to  raise  money,  and  had  a  pretty 
long  talk  about  it.   We  spent  a  whole  day  with  him  in  his  tank 
house— you  know,  the  big,  rural  tanks,  the  kind  with  the  long 
stilts  and  the  big  round  ball  on  top?  There  was  a  lot  of  space 
in  the  structure,  and  his  office  was  underneath  the  tank. 

We  took  an  elevator  up  there,  and  we  sat  in  this  wonderful 
location  at  UOP/COP  and  learned  how  you  raised  money,  how  you 
had  to  put  people ' s  names  on  things ,  and  how  you  had  to  do 
this,  and  how  you  had  to  do  that. 

Crawford:   Were  you  active  in  the  fund-raising? 


226 


Blum:      Not  really,  because  I  came  to  the  university  at  that  point.   I 
resigned  there,  saying,  "I  work  here;  I'd  better  not  play  games 
out  there." 


Crawford:   You  moved  here,  I'm  assuming,  as  soon  as  you  changed  jobs? 

Blum:      I  moved  here,  yes,  within  the  year.   So  I  left  that  behind,  but 
then  my  wife  knew  about  all  these  games  that  were  going  on  at 
JFK,  like  getting  the  library  and  accreditation  together,  and 
that  we  got  a  big  piece  of  land  from  a  lady  in  Yolo  County  who 
thought  that  we  were  going  to  move  there,  and  I  don't  think 
that  Harry  dissuaded  her. 

We  moved  here.   One  day  my  wife  is  in  Safeway,  and  she 
hears  a  lady  talking  to  an  old  friend—they  're  meeting  at  the 
counter- -and  saying,  "Where's  your  son?"   "Oh,  he's  out  at  JFK 
University."  My  wife  couldn't  believe  it  was  real  because  she 
knew  all  the  monkey  business  side  of  it.   So  she  turned  to  the 
lady  and  said,  "Going  to  school  out  there?  Really?"   "Oh,  yes. 
There's  six  thousand  students."   She  remembered  very  well  the 
two  Sundays  I  had  to  go  over  there  when  we  first  got  the 
funeral  parlor  and  help  clean  it  up.   There  were  these  big 
baskets  where  you  kept  people,  and  there  were  thumbscrews—to 
keep  people  looking  relaxed- -well,  we  got  quite  an  education  at 
the  funeral  parlor.   We  painted,  we  cleaned,  we  scrubbed,  and 
there  it  was.   I  can  tell  you  that  some  of  us  got  a  little 
queasy.   We  just  weren't  used  to  the  undertaking  business. 

Crawford:   What  is  the  reputation  of  the  school? 


Blum: 


Pretty  good,  pretty  good.   The  psychology  thing  is  fun.   There 
are  some  fun  people  there,  and  we  had  quite  a  day  a  couple  of 
weeks  ago  when  I  gave  a  two-hour  class  on  aging  and  the  utility 
of  combined  human  services. 


Crawford:   You  can  get  your  degree? 

Blum:      Oh,  yes,  and  they  contribute  people  to  Over  60 's  clinic  to  work 
there.   Over  60  has  volunteers  from  both  students  and  faculty. 
So  it's  a  real  part  of  the  community;  it's  for  real  and  it's  a 
big  operation.   So  I  always  feel  good  about  JFK  University. 

Well,  there's  one  other  stream  of  concern  from  Contra  Costa 
that  also  influenced  much  of  my  life  ever  since  I  left  there. 
I  wasn't  there  too  long  when  I  discovered  that  a  couple  of 
optometrists  who  belonged  to  the  Lion's  Club--the  Lion's  Club 
is  always  doing  things  with  vision—were  going  to  do  an  eye 
exam  of  every  grade-school  student  in  Contra  Costa  County  to 
find  the  kids  who  couldn't  see  well  and  needed  care.   That's 


227 


always  been  a  problem.   People  wonder  why  their  kid  drives  a 
bicycle  down  the  stairs  and  never  seems  to  learn--well,  maybe 
they  can't  see.   So  the  whole  business  of  learning  in  schools 
is  partly  lost  on  kids  who've  never  seen  the  blackboard  and 
don't  see  the  teacher  all  that  well. 

They  are  going  to  do  a  real  checkup,  but  there's  great 
argument  in  the  field  about  how  best  to  do  it.   The 
ophthalmologists  don't  want  anything  to  do  with  it;  they  say, 
"Let  the  school  nurses  use  an  eye  chart,"  and  the  optometrists 
are  saying,  "That's  pretty  sick.   It  ought  to  be  done 
properly. " 

So  the  optometrists  got  some  big  machinery  and  planned  to 
do  the  whole  county.   The  only  catch  is  when  the  optometrists 
go  into  the  school  district,  every  kid  who's  found  to  have  a 
problem  tends  to  be  sent  to  the  optometrist  who  came  in  to  do 
the  exams.   It's  just  the  way  it  would  work  out.   Whose  card 
are  you  going  to  give  them  if  the  kid  needs  eye  care? 

Well,  that's  pushing  it  a  little--that ' s  unfair  trade;  and 
I  hear  about  it  from  the  school  superintendent.   "We're  getting 
ready  to  have  this  big  thing,  is  this  all  right?   Does  this 
make  sense?"  He's  calling  the  health  officer  for  advice.   I 
said,  "Hold  it  up  just  a  little  bit,  and  let  me  think  about 
it."   So  I  found  some  articles  in  the  literature,  and  those  two 
instruments  they  were  going  to  use  gave  terrible  results.   They 
refer  about  as  many  people  who  are  normal  as  they  do  abnormal, 
and  they  miss  about  half  of  the  abnormals.   Those  two  machines 
are  not  worth  a  damn. 

So  I  said,  "Well,  these  folks  are  serious,  and  the  Lions 
are  serious,  so  why  don't  we  really  figure  out  how  to  do  it 
properly?  Let's  set  up  the  Orinda  Vision  Study."   It  wasn't 
called  that  then,  but  we  would  pick  a  community  where  everybody 
could  afford  to  go  to  the  doctor,  so  we  wouldn't  be  examining 
kids  who  could  not  get  needed  care  afterwards.   When  we  got 
through  testing  with  seven  methods  that  we  knew  about,  we  could 
send  a  group  of  these  children  to  UC  Berkeley  Optometry  and  to 
Stanford  Medical  School  Ophthalmology- -which  was  in  San 
Francisco--to  be  reexamined  to  see  how  good  these  tests  were. 

We'd  have  all  the  reports  from  all  the  tests  in  front  of 
us ,  and  every  kid  who  was  found  with  something  abnormal  would 
go  to  these  two  centers,  as  well  as  a  sizeable  group  of 
normals.   It  really  was  the  first  good  vision  study  ever  put 
together. 


228 


Crawford: 
Blum: 


I  decided  that  we  would  do  the  testing  out  of  our  own 
budget,  but  we  needed  a  little  extra  for  records  and  phone 
calls  to  parents  about  the  results.   The  county  administrator 
who  had  been  involved  in  selecting  me  for  the  job  said,  "All 
right.   The  county  will  put  in  five  hundred  bucks."  Well, 
that's  nothing  for  a  study  like  that,  but  really  it  was  good. 
The  optometrists  will  do  their  tests  for  free;  our  staff  will 
do  the  other  tests.   Then  we  have  to  call  the  parents. 

It  was  a  perfect  situation,  and  the  logic  was  that  poor 
people  don't  have  much  different  eye  trouble  than  well-off 
people,  therefore,  we're  going  to  work  with  the  well-off  people 
who  could  get  the  tests  at  UCB  and  Stanford,  as  well  as  buy 
needed  care,  glasses,  whatever. 

We  got  the  state  health  department  to  do  the  statistics. 
We  found  an  optometrist,  who  was  a  neighbor  of  mine  and  a 
professor  at  UCB,  and  who  later  became  the  head  of  health 
sciences  at  an  Alabama  University,  to  invent  a  quick  way  of 
testing  in  the  schools. 

What  was  his  name? 

His  name  was  Henry  Peters.   He's  the  second  author  on  the 
study—the  Orinda  Vision  Study.   Henry  designed  a  whole  new  way 
of  testing  kids.   It  was  cheap  and  brilliant,  and  it  took  an 
optometrist  to  do  it.   Of  course,  they  were  willing  to  work  for 
nothing  to  prove  the  point  that  they  could  do  a  good  job. 

So  we  did  a  thousand  kids,  roughly,  in  Orinda  for  two 
years,  enough  to  follow  the  same  kids  to  see  if  they  changed, 
and  nobody  had  ever  done  that  before. 

What  we  discovered  was  that  not  only  did  we  find  all  the 
bad  eye  problems  that  we  needed  to  find,  but  we  also  discovered 
that  some  of  the  changes  at  the  end  of  the  year  were  not  the 
ones  that  were  predicted  in  all  the  textbooks,  which  is  that 
everybody  gets  more  and  more  short-sighted:  not  so.   And  there 
were  visual  changes  in  various  unexpected  directions.   There's 


a  huge  Vision  Orinda  Study  now  following  up  on  that, 
a  big-time  science  study. 


Now  it's 


Henry  Peters  developed  this  new  method,  which  was  called 
the  modified  clinical  technique  (MCT) .   I  phoned  all  the 
families  to  tell  them  about  the  findings.   I  made  all  the  phone 
calls  myself.   Every  time  that  I  got  to  a  father  in  Orinda,  I 
also,  ultimately,  had  to  talk  to  the  mother.   The  fathers  were 
of  no  use  whatsoever,  and  knew  it. 


229 


Crawford:   It's  not  their  business. 

Blum:      It's  not  their  business.   So,  here's  a  woman:  "You  called  my 

husband,  and  he  really  couldn't  tell  me  any thing- -what  is  it?" 
So,  I'd  say,  "Your  child  was  examined  and  we  found  nothing," 
or,  "Your  child  was  examined  and  there's  a  possibility  of  this, 
that,  and  the  other  thing;  and  we'd  like  the  child  to  go  to  two 
separate  universities--UC  Berkeley  and  Stanford—to  be  re- 
examined,"  if  that  was  the  case. 

Well,  to  make  a  long  story  short,  we  got  a  team  to  head  up 
the  study.   The  expert  from  Stanford  agreed--!  was  on  the 
faculty  at  Stanford,  at  that  time,  at  the  medical  school.   I 
went  to  Ed  Maumenee,  a  famous  ophthalmologist.   He  later  left 
to  head  up  the  Wilmer  Eye  Institute  at  Hopkins;  and  that's  the 
pinnacle.   When  he  left  Stanford,  he  picked  one  of  his 
associates  as  the  participating  doctor.   Well,  that's  all 
right.   That's  the  man's  name  that  appears  as  one  of  the 
authors  of  the  study.   In  any  case,  we  proceeded,  we  got  all 
the  results  together,  and  on  every  Thursday  night  for  one  year 
--I  had  all  the  records—we  sat  in  the  ophthalmologist's  office 
in  San  Francisco,  studied  the  results,  and  wrote  the  book.   The 
University  of  California  Press  published  it  in  1959,  and  it  was 
a  classic.1   I  could  go  anywhere  in  the  world  where  there  was  an 
optometrist  and  say  who  I  was,  and  they  would  bring  out  the  red 
carpet . 

Crawford:   That  was  very  exciting. 

Blum:      Yes,  and  what  it  did  was  mortify  the  ophthalmologists  because 
it  turned  out  that  the  optometrists  using  the  MCT,  which  cost 
fifty  cents  a  head  to  run,  had  found  everything  that  was  ever 
found  on  the  students  at  Stanford  or  at  UC  Berkeley  from 
traditional  extensive  testing.   It  was  a  brilliant,  really 
brilliant  inexpensive  screening.   It's  of  interest  that  the 
Department  of  Optometry  is  just  now  taking  the  MCT  to  China, 
where  they  will  train  people  to  use  it  and  then  do  all  the 
children  in  China. 

Henry  Peters  was  just  a  genius  at  this  sort  of  thing.   It 
brought  me  the  Apollo  Award  in  years  to  come,  an  annual  award 
from  the  American  Optometric  Association  for  a  non-optometrist. 
The  book  was  published  and  the  ophthalmologists  started 
screaming  bloody  murder.   It  was  in  the  code  of  ethics  of  the 
AMA  that  no  M.D.  shall  communicate  with  optometrists.   That  was 


'Vision  Screening  for  Elementary  Schools:  The  Orinda  Study.   Blum, 
Peters,  Bettman.   UC  Press,  1959. 


230 


inserted  in  the  code  by  request  of  the  ophthalmologists  in 
1955,  a  turf  matter,  of  course. 

Crawford:   Is  this  still  going  on? 

Blum:      Well,  no.   They  got  rid  of  that  law  a  decade  later.   As  soon  as 
we  were  published,  we  had  a  second  printing.   We  didn't  get  a 
dime  for  it  because  this  was  a  public  service  thing.   You  saw 
it;  it  was  in  soft  cover.   I  got  a  notice  from  the  AMA  that  I'm 
about  to  be  tried  for  unethical  behavior,  consorting  with 
optometrists,  but  they  are  sending  this  to  the  California 
Medical  Association  because  I'm  a  member  here. 

Then  I  get  a  letter  from  the  CMA  that  they're  sending  it  to 
the  ACCMA  because  I'm  a  member  of  the  Alameda/Contra  Costa 
Medical  Association,  and  I  will  have  a  trial  for  being 
unethical,  working  with  optometrists,  for  figuring  out  a  method 
of  testing  school  kids'  eyes  —  the  first  time  it's  ever  been 
done  properly,  and  a  beautiful  test,  besides. 

So  my  wife  says,  "We  don't  have  to  put  up  with  this.   You 
get  on  your  best  suit  and  go  down  there  and  sit  through  this 
hearing.   I'll  drive  you  down,  so  you're  relaxed.   If  there's 
any  crap,  you  just  tell  them  that  we're  going  to  hire  a  lawyer 
and  go  the  whole  way." 

I  had  a  committee  of  about  twenty  doctors,  headed  by  a 
urologist,  whose  son  is  now  a  very  prominent  urologist  down  the 
Peninsula.   They  sat  me  down  and  they  read  the  charges: 
cooperating  with  optometrists.   The  first  thing  they  wanted  to 
know  was,  "How  much  did  they  pay  you?"  Which  I  don't  think  was 
a  good  reflection  on  physicians  —  to  bring  that  up  as  the  first 
question.   I  said,  "They  didn't  pay  me  anything--! 'm  a  health 
officer."   "Well,  why  did  you  knuckle  under  to  these  rascals?" 
I  said,  "I'm  concerned  with  the  health  of  the  kids."   "Why 
didn't  you  use  ophthalmologists?"   I  said,  "Well,  the  truth  of 
the  matter  is  that  I  asked,  and  none  of  them  in  the  East  Bay 
wanted  to  play;  but  I  did  get  the  world's  most  famous 
ophthalmologist  to  play--Maumenee,  who  is  now  at  Hopkins." 
That  kind  of  cooled  them  off.   Then,  "How  much  did  you  make 
from  the  book  on  the  royalties?"  I  said,  "Well,  it  just  so 
happens  that  this  is  known  as  a  service  kind  of  book.   UC  Press 
does  not  pay  its  authors  anything  for  this  kind  of  book."   I 
said,  "Look,  we  ended  up  figuring  out  how  to  do  it  right,  and 
we  checked  it  out  all  the  way  around,  and  all  the  other  tests 
were  terrible;  we  tested  them  all.   They  said,  "Well,  would  you 
write  all  this  up?  We'll  send  it  on  to  the  AMA."  And  I 
submitted  it  shortly  after  that  time,  and  the  case  was  removed. 


231 


And  as  I  said,  this  portion  of  the  code  of  ethics  was  deleted 
by  the  AMA  a  decade  later. 

The  reason  I  wanted  to  get  into  this  study  for  a  moment  is 
that  this  all  started  as  a  health  officer  getting  five  hundred 
dollars  from  the  county  administrator,  who  is  putting  his 
blessing  on  it.   It  made  me  very  visible  to  the  optometrists 
because  I  took  the  heat  for  it—tried  for  being  unethical.   Of 
course,  I  was  exonerated,  but  the  optometrists  were  well  aware 
that  I  had  been  willing  to  put  my  name  up  front  when  it  was 
known  to  be  a  risky  thing. 

Crawford:   Had  you  jeopardized  your  position  at  Stanford? 

Blum:      Not  at  all,  not  Stanford,  and  with  their  celebrity  Dr.  Maumenee 
on  it.   But  it  is  of  interest  that  in  the  sixties,  the  UCB 
School  of  Public  Health  wouldn't  take  optometrists.   But  the 
same  university  has  a  school  of  optometry--the  best  in  the 
world. 

The  head  of  the  Health  and  Welfare  Committee  of  the 
California  State  Assembly  was  an  optometrist—Gordon  Duffy--and 
he  was  not  unaware  of  what  was  going  on.   I  worked  with  him  on 
committees,  and  then  one  day  I  was  sitting  at  my  desk  at  UCB, 
and  he  called,  "I'd  like  to  do  something  for  you-  -what  can  I 
do?"   I  said,  "Well,  we're  working  on  trying  to  set  up  a 
medical  school  at  Berkeley."   He  said,  "Good.   I'll  have  some 
policy  analysts  work  that  in  to  some  other  piece  of 
legislation,"  and  we  wrote  up  the  medical  school  at  UC  Berkeley 
that's  here  today  —  and  it  became  law. 


Blum:      I'll  continue  with  this  stream  of  events  which  eventuates  in 

the  medical  school  at  UCB,  known  as  the  Joint  Medical  Program. 

When  I  got  to  UCB  the  campus  under  Chancellor  Roger  Heyns 
was  looking  at  the  advisability  of  creating  a  medical  school  in 
the  East  Bay,  which  was  the  largest  population  aggregate  in  the 
U.S.  without  a  medical  school. 

Bill  Reeves  and  Ned  Rogers  were  on  a  campus  committee 
studying  the  pros  and  cons  and  Ned  became  the  chair.   When 
Roger  Heyns  left,  he  was  replaced  by  Albert  Bowker,  who  was 
specially  interested  in  a  medical  school,  having  just  launched 
an  unorthodox  one  at  City  College  of  New  York. 

The  committee  met  almost  weekly  for  lunch  in  Bowker  's 
office  and  chewed  over  every  aspect  of  the  matter.   I  was 


232 


appointed  to  it  shortly  after  my  arrival  and  enjoyed  every 
minute  of  the  planning  for  a  medical  school  without  walls, 
using  primarily  local  practitioners  as  faculty  and  the 
available  campus  courses  for  the  basic  sciences.   There  was 
such  a  school  at  Michigan  State  just  being  set  up  by  a  former 
dean  of  the  medical  school  at  Stanford.   He  became  one  of  our 
outside  advisors,  bringing  with  him  a  faculty  person  in  charge 
of  their  pediatrics  and  genetics  who  spent  a  year  here. 

As  we  got  closer  to  a  conclusion,  we  worked  with  our  two- 
county  medical  society,  ACCMA,  won  its  hearty  approval  as  its 
members  would  be  playing  such  a  key  role  in  teaching. 

However,  the  president's  office  at  UC  was  getting  a 
powerful  barrage  against  the  unorthodox  proposal  from  the  other 
medical  schools  in  the  system.   They  didn't  want  to  share  any 
funding  with  another  medical  school  and  they  hated  the  proposed 
unorthodox  approaches  to  teaching  as  well  as  the  offensive 
notion  of  training  primary  care  or  people-oriented  physicians. 

A  canvass  of  UC  medical  school  deans  showed  only  one  in 
favor.   The  very  antiquated  dean  at  UCLA  was  away  and  a  friend 
of  mine  from  Hopkins  days  was  acting  dean.   He  called  me  and  I 
helped  him  compose  a  very  positive  letter. 

At  that  point  the  president  of  the  university,  a  well  known 
planner  by  the  name  of  Charles  Hitch,  sent  Bowker  a  letter 
advising  him  to  forget  the  medical  school.   Bowker  was  a  soft- 
spoken  man  of  action,  and  used  few  words.   At  our  weekly 
meetings,  he  rarely  spoke,  but  when  he  did  it  was  decisive  and 
to  the  point.   Bowker  raised  his  hand  and  asked  our  committee's 
permission  to  read  a  letter  from  President  Hitch  which  went  to 
the  effect  that  it  was  time  to  bury  the  Berkeley  Medical 
School.   It  opened,  "Dear  Al." 

Bowker  then  said  he  would  like  to  read  us  his  reply,  which 
was,  "Dear  Charlie,  thought  you'd  be  interested  in  the 
enclosed."  The  enclosed  was  the  new  state  law  I  had  handed  him 
a  day  before  which  had  just  been  enacted  saying  that  "there 
shall  be  a  medical  school  at  UCB." 

I  won't  go  through  the  school's  ups  and  down,  except  to  say 
that  Robert  Biller,  now  provost  at  USC  and  then  associate 
professor  in  public  policy,  provided  the  intellectual  and 
philosophical  framework  for  the  effort.   He  became  the  first 
director  of  Health  and  Medical  Sciences  which  had  five  arms  —  an 
undergraduate  effort  for  the  pre-health  career  students,  an 
unorthodox  breed  of  intermediate  level  mental  health 
professionals,  the  unorthodox  medical  school,  a  genetics 


233 


counseling  program,  and  a  dual  degree  effort  under  Dr.  Leonard 
Duhl. 

Although  I  had  opted  for  the  undergrad  program  where  some 
four  or  five  thousand  pre-med,  pre-dental,  pre-nurse  students 
throve  on  Shakespeare  and  chemistry  and  needed  some  sense  of 
what  they  were  getting  into,  I  was  soon  detoured  into  the 
medical  school  and  put  in  charge  of  the  clinical  aspects 
because  I  was  the  only  M.D.  on  the  committee  that  knew  great 
numbers  of  local  physicians,  hospitals,  health  departments,  and 
had  also  taught  in  medical  schools. 

I  became  half-time  with  the  medical  school  and  organized 
the  medical  exposures  of  the  twelve  students  in  the  entering 
class,  found  them  practitioner  preceptors,  organized  physical 
diagnosis,  hired  the  clinical  professors  who  opened  up  the 
program.   I  found  these  people  with  the  help  of  Dr.  Norman 
Sweet  of  UCSF,  a  student's  hero,  and  Dr.  Sheldon  Margen  of  the 
School  of  Public  Health,  who  had  just  left  private  practice  in 
Berkeley  for  a  professorship  at  UCB  and  had  been  our  family 
doctor  (he's  the  father  of  the  Berkeley  Wellness  Newsletter). 

Another  new  president  of  the  UC  system  forced  us  into  a 
joint  venture  with  UCSF  so  as  to  avoid  creating  a  full-fledged, 
four-year  medical  school  in  the  East  Bay.   I  had  my  last  tangle 
with  UCSF  over  the  transfer  of  our  students  to  UCSF  for  their 
third  and  fourth  years  and  thus  their  M.D.  degree.   They 
decided  that  they  would  not  accept  our  students  after  all. 
That  was  a  potentially  lethal  blow.   So  I  went  to  work  and 
called  in  all  my  chits.   Stanford  agreed  to  take  six  of  the 
twelve,  USC  one,  Harvard  one,  Rochester  one,  Hopkins  one,  and 
at  that  point  UCSF  said  they  were  just  kidding,  they  would  take 
the  whole  class,  provided  they  got  half  the  faculty  funding, 
which  they  did.   About  half  of  our  first  class  did  go  to  UCSF 
and  all  of  them  have  from  then  on. 

Since  a  partnership  with  my  beloved  alma  mater,  UCSF,  was 
not  what  I  had  been  working  for,  I  left  the  program  in  about 
1974  and  never  touched  it  again  until  1991. 


Business  Activities  in  Contra  Costa  County  if 


Blum:      By  1960  I  had  done  quite  a  few  things.   I  had  finished  my 

vision  study  and  was  writing  my  book  on  administration  and  was 
probably  a  little  tired  of  Contra  Costa  at  that  point,  I'm  not 
sure.  So  I  started  looking  around,  and  I  thought  other  people 


234 


in  the  health  department  might  be  interested  in  opening  a 
really  good  medical  practice.  We  looked  at  a  walnut  orchard  in 
Concord  and  thought  that  might  be  a  good  place  for  a  health 
center.  We  bought  the  land  inexpensively  and  then  got  cold 
feet  about  going  into  practice.   Subsequently  we  thought  we 
might  want  to  make  a  shopping  center.   We  couldn't  get  zoning 
for  that,  and  then  we  sat  there  on  this  sizable  investment--! 'd 
involved  all  my  friends  and  all  the  doctors  in  the  department, 
and  even  my  secretary.   So  we  created  a  corporation  and  we'd 
had  a  dream  of  building  low-cost  housing  there  and  couldn't  do 
that  for  other  reasons,  primarily  financing.   We  created  three 
corporations:  a  real  estate  managing  group,  a  real  estate 
development  group,  and  a  construction  company. 

We  finally  built  a  mobile  home  complex.   Our  one 
businessman  partner  had  an  unerring  eye  for  what  should  be 
bought  and  what  sold.   He  received  10  percent  off  the  top  for 
each  purchase  and  likewise  for  each  sale,  a  potential  gold  mine 
for  him,  but  he  just  couldn't  resist  helping  himself  to  our 
assets,  since  he  was  also  our  manager  for  the  mobile  home  park 
and  for  our  construction  company. 

Fortunately,  he  had  to  go  away  for  a  national  convention  of 
his  service  club,  and  I  automatically  took  over  the  paperwork. 
It  was  pretty  shocking  to  discover  that  we  hadn't  been  paying 
our  bills  and  that  we  owed  some  $80,000  just  to  our  lumber 
company.   I  removed  all  the  files  from  his  office,  went  through 
our  finances,  and  discovered  that  the  missing  funds  had  gone  to 
building  him  a  magnificent  home. 

Just  prior  to  this  rude  awakening,  our  last  quarterly  board 
meeting  had  taken  on  a  bizarre  set  of  new  rituals.   First  a 
minister  came  and  gave  us  a  blessing,  and  then  we  had  a  flag  to 
salute.   The  reasons  for  the  appearance  of  these  morally 
edifying  rituals  was  soon  evident.   Fortunately,  I  had  all  this 
partner's  shares  in  these  three  corporations  in  my  safe  deposit 
box  and  it  wasn't  too  hard  to  set  the  accounts  straight,  and 
divorce  our  errant  partner. 

In  addition  to  learning  about  partners,  we  learned  a  lot 
about  real  estate  zoning,  borrowing,  naming  business 
corporations,  and  some  basic  rules  of  survival. 

One  of  the  socially  useful  things  we  tried  to  do  was  create 
elderly- friendly  low-cost  housing.   We  found  an  Oakland 
architect  who  specialized  in  such  work  and  created  a  plan  for 
three  low-cost  acres  in  Concord,  which  were  really  a  marsh 
between  two  creeks  that  were  being  rerouted.   The  marsh 
disappeared  and  became  a  lovely  gentle  hill  when  all  the  local 


235 


contractors  used  it  as  a  dump  for  their  unwanted  fill.   I  was 
in  Washington  frequently  and  went  to  see  the  FHA  office  that 
also  guaranteed  loans  for  elderly  housing.  All  that  they 
required  was  a  location  three  blocks  from  a  shopping  center, 
which  we  were,  less  than  35  percent  coverage  of  the  lot,  which 
no  developer  could  afford,  and  concrete  and  steel  construction 
with  elevators  for  a  two-story  building  for  people  who  were 
currently  living  in  multistory  fire  traps  paying  several  times 
what  we  would  be  charging. 

When  I  asked  the  federal  loan  officer  if  he  was  ever 
concerned  with  creating  low-cost  safe  housing  for  the  elderly, 
he  allowed  that  that  was  never  a  consideration  in  their 
offices.   They  were  concerned  with  keeping  real  estate 
interests  and  contractors  happy.   We  sold  the  land  to  a  real 
estate  developer  who  had  ample  funds  and  built  lovely 
apartments  with  tree-shaded  walks,  but  for  better-off  people, 
aged  or  otherwise. 

Another  lesser  disappointment  was  my  design  effort  for  the 
mobile  home  park  which  we  called  The  Trees  because  it  was  going 
into  an  older  walnut  orchard.   We  surveyed  it  and  I  designed 
the  park  so  that  we  would  spare  almost  all  the  trees.   In 
Concord's  warm  climate,  that  would  be  quite  an  asset.   What  1 
forgot  was  that  all  the  utilities  which  were  going  underground 
had  to  get  to  the  unit  pads,  and  inadvertently,  we  lost  about 
half  of  the  remaining  trees  as  a  result  of  placing  the 
utilities  to  the  pads. 

I  did  all  this  in  early  mornings  before  arriving  at  work  in 
the  health  department,  in  the  evenings,  and  on  weekends.   Once 
the  new  ideas  were  in  place,  the  only  interesting  aspects  were 
new  acquisitions  and  design  of  new  structures.   But  the 
nuisance  of  day-to-day  transactions,  after  they  fell  on  me, 
weren't  worth  the  efforts,  and  since  no  one  else  wanted  to  take 
over,  we  began  closing  out.   It  took  about  ten  years  to  get  rid 
of  the  last  bits  and  pieces,  but  it  was  all  very  profitable  for 
all  the  partners  and  everyone  left  with  a  good  feeling, 
although  it  was  apparent  that  we  could  all  have  become 
millionaires  in  that  real  estate  boom  if  we  had  stuck  it  out, 
and  if  I  had  continued  the  managing  and  entrepreneuring,  which 
none  of  us  looked  forward  to. 

One  of  the  side  effects  of  my  business  matters  was  the 
status  it  earned  me  among  some  physicians.   Physicians  in  fee- 
for-service  practice  (the  main  form  of  practice  then)  were  not 
overwhelmed  with  respect  for  public  health  M.D.s  whom  they 
regard  as  salaried  renegades  and  traitors,  or  as  physicians 
incapable  of  making  a  living  in  practice.   In  fact,  in  the 


236 


western  end  of  the  county,  I  was  cordially  hated  in  some 
quarters  because  we  held  free  well-baby  clinics,  prenatal 
immunization,  birth  control,  and  children's  cardiac  clinics, 
among  others.   Scathing  letters  would  go  to  the  medical  society 
about  my  socialistic  tendencies,  i.e.,  stealing  private 
practice  patients.   Then  I  would  go  to  a  medical  society 
council  meeting  and  explain  our  work,  our  duties,  the  laws  we 
were  under,  and  get  a  grumbling  acquiescence.   As  a  result  of 
the  success  of  the  mobile  home  park,  I  was  invited  to  address  a 
hospital  staff  meeting  on  investing  in  real  estate,  although 
the  meeting  was  billed  as  something  about  health. 


A  House  in  Berkeley 

[Interview  5:  March  29,  1997]  ## 


Blum:      In  the  final  chapter  of  this  relatively  important  break  in  our 
history,  we  moved  to  Berkeley.   We  came  here  in  1966,  and 
somewhere  around  that  time  I  got  a  Margaret  Sanger  Award  from 
Planned  Parenthood.   When  we  got  to  Berkeley,  we  decided  to 
build  a  house  and  bought  a  lot.   But  I  couldn't  get  a  building 
permit.   We'd  bought  the  land,  had  a  surveyor,  architects, 
contracts,  everything  ready  to  go;  and  the  city  wouldn't  sign 
the  building  permit. 

We  fooled  around  for  a  while,  and  finally  I  thought,  "I 
wonder  if  there's  something  political  about  all  this."   I  went 
down  to  the  building  department  and  the  building  inspector 
wasn't  in,  although  I  had  made  an  appointment. 


Blum:      I  remembered  my  days  in  San  Diego,  Contra  Costa,  and  elsewhere 
--you  deal  with  people  who  seem  to  have  authority,  and  maybe 
you  just  have  to  play  the  game  better  than  they  do.   I  said  to 
his  assistant,  "Well,  I'll  just  sit  here.   I'll  clear  my 
schedule  and  I'll  be  here  tomorrow.   I  know  the  chief  is  bound 
to  come  to  his  office,  and  I'll  be  here."  That's  the  sort  of 
treatment  that  they  don't  know  how  to  deal  with. 

In  any  case,  the  assistant  inspector  who  had  spoken  to  me 
was  very  embarrassed  about  all  of  this.  He  was,  clearly,  very 
uncomfortable  when  I  couldn't  get  a  permit  signed.  So,  when  I 
came  the  next  day,  he  said,  "Come  in  the  office  and  sit  here." 
We  sat  down  and  chatted  a  little  bit  about  things,  and  he  said, 
"You're  a  famous  person,  aren't  you?"  I  said,  "Me?"  He  said, 


237 


Crawford: 
Blum: 

Crawford: 
Blum: 


Crawford; 
Blum: 


Crawford: 


Blum: 


"Oh,  yes,  you."   I  said,  "How  would  you  figure  that  out? 
Nobody  ever  told  me  that  before."  Well,  he  said,  "Didn't  you 
get  a  Margaret  Sanger  Award?"   I  said,  "Well,  that's  true,  but 
I  wouldn't  say  that  I'm  really  famous."  He  said,  "Oh,  yes. 
That's  a  very  important  thing.   You  know,  I  wish  we  had  known 
about  those  things  when  we  got  married.   We  have  an  awful  lot 
of  kids."   [laughs]   He's  sitting  there,  admiring  me,  and  he 
said,  "Give  me  that  goddamned  permit,"  and  he  signs  it  and 
says,  "Go  ahead—build  your  house."   [laughs] 

This  is  very  puzzling,  though.   What  was  the  basis  of  their--? 

Of  their  holding  it  up?  Well,  I  learned,  ultimately,  after  the 
house  was  built.  It  turned  out  that  nobody  in  the  neighborhood 
was  in  agreement.  They  just  didn't  like  the  house. 

Really?   The  plan? 

Yes.   It  was  something  I  did  myself,  and  really  very 
conservative,  with  shingles  and  two  almost  flat  roofs--you 
could  say  two  matchboxes  lying  one  next  to  the  other,  with  one 
roof  overshooting  the  other  and  facing  north—really,  a  very 
attractive  house,  everybody  said.   It  turns  out  that  a  fair 
number  of  neighbors  had  Cape  Cod  houses,  and  a  fair  number  had 
Spanish  houses,  and  they  were  seeking  a  compromise  on  a  Spanish 
Cape  Cod.   [laughter] 

They  didn't  come  forward  and  say,  "This  is  what  we  think"? 

Oh,  no.   We  had  a  hearing  because,  I  think,  we  came  closer  to 
the  street  by  a  couple  of  feet  than  was  allowed,  and  the  issue 
of  style  never  came  up.   A  neighbor  told  me  about  the 
reservations  years  later—one  of  the  neighbors  who  had  lived 
there  all  of  his  life  in  a  Cape  Cod  house. 


That  brings  you  to  Berkeley  and  your  house, 
your  house? 


Do  you  still  like 


Oh,  we  love  it,  yes.   I  somehow  knew  Roslyn  Lindheim— does  that 
name  mean  anything  to  you?  Well,  she  was  a  professor  of 
architecture,  here,  and  a  very  unusual  person. 

My  appointment  here  for  a  few  years  was  half-time  to  the 
Department  of  City  and  Regional  Planning,  half-time  to  the 
Department  of  Public  Health,  so  I  had  a  foot  in  each  of  those 
places.   City  and  Regional  Planning  is  the  sibling  of 
Architecture  and  Landscape  Architecture  in  the  Department  of 
Environmental  Design,  so  I  was  on  the  faculty  at  the  Department 
of  Environmental  Design  here,  and  I  guess  I  met  Roz  that  way. 


238 


Since  we  were  contemplating  building  and  had  bought  the 
lot,  I  asked  Roz  to  come  and  look  at  it,  and  look  at  my  design. 
Then  I  said,  "Roz,  would  you  care  to  be  a  consultant  on  the 
project?"  She  said,  "Well,  would  you  listen  to  a  consultant?" 
I  said,  "Well,  no,  probably  not."  She  said,  "Well,  then  what 
do  you  want  to  pay  one  for?"   [laughs] 

We  became  good  friends  over  the  years  —  a  very  interesting 
person—passed  away  now— but  she's  the  one  who  thought  up  the 
concept  of  On  Lok.   That  didn't  start  from  anywhere  else.   This 
was  Roslyn  Lindheim.   Do  you  remember  the  Plane  Tree  in  San 
Francisco—the  place  where  folks  could  get  information  about 
health  and  sickness?   It  was  right  near  Stanford  Medical 
School— it  was  the  old  medical  school  library— and  when 
Stanford  became  California  Pacific  Medical  Center,  Plane  Tree 
ended  up  having  a  ward  in  the  hospital  called  the  Plane  Tree. 
It  was  a  different  kind  of  service  where  people  were  treated  in 
a  very  different  way.   All  of  this  was  Roz  Lindheim  also. 

Crawford:   Where  was  it,  exactly? 

Blum:      It  was  a  ward  in  CPMC,  but  the  original  little  library  that  the 
public  could  use— which  had  the  technical  articles  and  the  not- 
so  technical  articles— was  right  next  door  to  the  old  Stanford 
Medical  School,  which  is  where  CPMC  is  now  located. 

Roz  worked  for  Stone,  Maracini  and  Patterson,  the  big 
hospital  architects.   She  was  one  of  their  head  architects,  and 
she  got  to  hate  hospitals,  or  to  be  exact,  the  process  of 
hospitalization.   She  thought  of  all  the  ways  of  avoiding 
hospitalization,  or  at  least  of  making  it  bearable,  that  was 
the  Plane  Tree  unit,  and  that's  what  On  Lok  was  all  about— 
avoiding  hospitalization  altogether. 

In  any  event,  Roz  was  the  consultant  for  our  house,  and  she 
made  two  suggestions,  shorten  an  overhang  and  take  out  a  corner 
where  the  hall  entered  the  living  room. 

Then  I  took  my  plans  to  an  architect  in  Walnut  Creek;  I 
didn't  know  the  engineering;  I  didn't  know  the  right  size  of 
windows— all  the  things  that  make  a  difference,  that  make  it 
simple  to  build  or  complicated.   He  took  my  floor  plan  and  the 
side,  front,  back,  views,  and  he  put  the  plan  together.   Well, 
it  wasn't  Spanish  and  it  wasn't  Cape  Cod. 

Crawford:   And  it  was  accepted? 


239 

Blum:      Yes.   Nobody  seemed  to  want  to  fight  very  hard,  and  it's  still 
there. 

Crawford:   And  you're  still  in  it? 
Blum:      Oh,  yes. 


Health  Officer,  Contra  Costa  County,  1950. 


President,  Health  and  Welfare  Council 
of  Contra  Costa  County,  196A-65. 


Teaching  at  the  University  of  California, 
San  Francisco,  1969. 


Opening  of  the  Joint  Medical  Program  at  the  University  of 
California,  Berkeley,  1972. 


240 


VII   MOVING  TO  BERKELEY:  THE  UNIVERSITY  AND  OTHER  INVOLVEMENTS: 
1966-1984 


Joining  the  University  of  California  Faculty  and  a  Campus 
Revolt 


Crawford:   That's  grand.   And  that  brings  us  to  Berkeley. 

Blum:       I  started  full-time  in  Berkeley  in  '66,  and  that  was  an 

auspicious,  grim  year.   And  a  few  years  thereafter  Mr.  Nixon 
had  us  invade  Cambodia.   This  place  really  blew  up  again. 
Students  and  even  faculty.   I  mean,  what's  the  use  of  teaching, 
what's  the  use  of  learning  if  we're  just  going  to  invade 
countries  —  take  out  a  whole  country  because  we  didn't  like  the 
Vietnamese.   We're  going  to  clean  out  Laos  and  Cambodia  because 
our  enemies  were  using  routes  through  those  countries  to  move 
equipment  and  supplies  and  troops;  we  just  extend  the  war  at 
will.   This  place  blew  up.   We  had  an  official  holiday  here. 
There  were  very  few  classes. 

Crawford:   You  were  familiar  with  UC  as  a  lecturer. 

Blum:      Well,  to  backtrack,  I  had  come  in  for  one  course  a  semester,  or 
sometimes  for  two  semesters  a  year  since  1951,  to  give  some  of 
the  regular  courses  in  the  School  of  Public  Health. 

Crawford:   So  that  you  knew  the  dean  and  you  knew  the  faculty? 

Blum:      Sort  of.   The  dean  had  a  long  history  of  relationships  with  me, 
as  you  know.   It  was  Chuck  Smith,  who  was  world-famous.   He 
discovered  and  clarified  a  horrible  disease,  valley  fever  or 
coccidioidomycosis.   Chuck's  name  became  synonymous  with  that, 
but  he  was  also  the  dean  at  the  School  of  Public  Health  when  I 
first  came  back  to  this  area  after  Harvard  and  from  San  Diego. 
I  came  to  Contra  Costa  in  1950,  and  I  thought  it  would  be  nice 
to  teach  somewhere,  so  I  came  over  to  the  university,  here. 
The  School  of  Public  Health  at  one  time  was  housed  in  one  of 


241 


Crawford: 
Blum: 


the  crummy  little  World  War  II  relics  in  the  glade  there  near 
the  library  known  as  the  "Temporaries." 

Ned  Rogers,  who  was  the  head  of  administration  and  a  very 
nice  person,  said  they  didn't  need  anybody,  but  Bill  Reeves, 
who  now  has  the  office  next  to  me  and  who  soon  became  the  dean 
after  Chuck  Smith  died,  thought  they  could  use  me,  and  they  had 
a  very  special  use  for  me  —  teaching  epidemiology  to  students 
who  didn't  speak  much  English,  or  to  students  who  had  no 
science  background,  so  that  they  were  presumably  incapable  of 
handling  the  material.   [laughs] 

They  got  rid  of  those  students  out  of  the  epidemiology 
classes,  and  gave  them  to  me.   I  had  a  great  time,  because  it 
just  suited  my  needs.   I  knew  epidemiology  pretty  well, 
although  I'd  never  had  a  course  in  it.   It  was  a  natural  kind 
of  teaching--it  was  cause  and  effect,  relationships, 
correlations—all  the  stuff  that  came  naturally  to  me. 

You  said,  when  I  first  talked  to  you,  "I  thought  this  way." 

Yes,  so  I  had  a  great  time  with  these  students,  and  some  of 
them  really  learned  more  than  they  ultimately  would  have  in  the 
regular  courses. 

This  was  my  relationship  with  the  school,  on  and  off. 
Chuck  Smith  was  called  the  first  dean  here;  he  was  really  the 
second,  it's  a  long  history—it' s  in  Bill  Reeves'  oral  history. 
But  Chuck  Smith  had  sat  on  the  examining  boards  for  me  in  two 
places,  when  I  applied  to  Contra  Costa  for  the  health 
officership  and  when  I  applied  to  San  Mateo.   In  both  cases,  he 
saw  to  it  that  I  was  number  one  on  the  list.   There  wasn't  any 
question  that  he  knew  who  I  was,  so  when  I  showed  up  around  the 
school,  he  seemed  interested  in  putting  me  on.   He  was  closer 
to  epidemiology  than  he  was  to  administration.   In  any  event,  I 
later  moved  from  that  to  teaching  administration  when  they  had 
some  holes  in  the  administration  faculty. 


Blum:      One  of  my  early  teaching  successes  was  with  a  group  of  master's 
students  learning  more  about  administration.   A  good  many  had 
experience  and  all  in  all  we  had  a  lively  two-hour  seminar  each 
week.   It  was  often  a  shared  session  with  Al  Leonard  with  whom 
I  later  wrote  a  text  on  administration.   The  class  began  at  ten 
a.m.  and  nobody  seemed  to  want  to  quit  at  noon. 

In  the  next  year  using  our  same  open-ended  approach  with  a 
very  comparable  group  of  students,  the  class  was  okay,  but 


242 


Crawford: 


Blum: 


never  was  scintillating  as  in  the  year  before.   The  third  year 
was  about  like  the  second  one.   At  one  bull  session  about  how 
courses  worked  and  didn't  work,  I  learned  that  in  the  first 
year  in  the  eight-  to  ten-a.m.  time  slot  preceding  our  ten-  to 
twelve-session,  Helen  Ross,  more  recently  the  head  of  health 
education  at  San  Jose  State  University,  had  been  doing  her 
thing  for  the  same  group  of  students  who  stayed  on  in  the  same 
room  for  our  class.   Her  thing--how  to  turn  students  on  and  get 
them  enthused.   But  she  was  no  longer  there  in  our  second  and 
third  year  repeat.   I  have  always  been  suspicious  that  Helen 
Ross  was  the  cause  of  our  first-year  success.   Perhaps  a 
successful  class  depends  heavily  on  what  has  happened  to  the 
students  in  the  hours  just  prior  to  getting  to  one's  class,  not 
on  the  giftedness  of  the  instructor  in  the  class. 

f* 

You  told  me  there  was  nothing  for  you  to  do  because  there 
wasn't  much  going  on  in  the  area  of  administration. 

Yes,  but  I'd  written  that  book  on  administration  [Public 
Administration:  A  Public  Health  Viewpoint] .   I  was  fairly  well 
known  to  a  lot  of  people. 


Crawford:   And  there  was  a  Stanford  connection,  as  well? 

Blum:      Well,  that  was  another  story.   That  was  every  Friday  afternoon, 
beginning  in  1950,  when  I  came  back  to  the  Bay  Area,  right  up 
to  1960,  when  Stanford  Medical  School  left  San  Francisco  and 
went  down  to  the  Farm.   I  kept  on  for  three  more  years,  but 
that  was  a  big  commute  to  Palo  Alto  and  I  couldn't  keep  it  up. 
That  was  teaching  straight  internal  medicine. 

The  first  week  that  I  came  to  work  at  UCB  as  a  professor,  I 
got  a  call  from  Stanford  from  then-dean  Glaser  saying,  "Come  on 
down  and  talk  about  teaching  preventive  medicine  at  Stanford." 
I  would  have  loved  to  do  that,  because  the  place  where 
preventive  medicine  is  needed  is  in  medical  school.   Everybody 
who  comes  to  a  school  of  public  health  has  already  figured  out 
that  that's  their  baby.   In  medical  school,  that's  not  friendly 
territory,  but  has  to  be  made  so. 

I'd  had  a  talk  with  Glaser  about  that  a  few  years  before. 
He  said,  "We  don't  have  a  professor  in  that,  so  we  can't  do 
preventive  medicine  now,  but  I'll  call  you  as  soon  as  it  looks 
like  we  can."  So  he  called  me,  and  I  turned  him  down.   I  said, 
"I  can't  leave  Berkeley;  I  just  got  here." 

Crawford:   Would  that  have  been  a  full-time  association? 


243 


Job  Offers  from  Stanford.  New  York  City,  and  Los  Angeles  Health 


Blum:      Oh,  yes.   It  would  be  part  of  the  faculty.   It's  really  where  I 
wanted  to  be.   Well,  that  was  a  wild  first  week  here.   I  got  a 
call  from  a  man  who  once  worked  for  me  and  then  ran  a  voluntary 
health  agency  that  had  been  the  backbone- -they  and  the  PTA--of 
our  doings  in  Contra  Costa  County.   He  said,  "I'm  bringing  up 
three  members  of  the  board  of  health  of  Los  Angeles  County.   We 
have  the  blessing  of  three  supervisors  of  the  five,  and  we  want 
to  talk  to  you  about  coming  to  L.A.  to  head  up  the  health 
department  (which  had  recently  combined  the  city  and  county 
health  departments).   I'm  representing  the  voluntary  health 
agencies,  and  we  promise  you  every  conceivable  support.   We 
just  want  to  clean  this  mess  up."   It  was  really  a  bad  scene. 
At  the  same  time,  practically  at  the  same  moment,  I  got  a  call 
from  Bob  Connery,  who  was  the  chief  of  administration  for  the 
City  of  New  York,  for  Mayor  Lindsay.   Do  you  remember  that 
bright,  shining  light? 

Crawford:   Yes. 

Blum:      He  was  a  Space  Cadet--this  Connery--a  professor  of  political 
science  at  Duke.   That  was  the  kind  of  people  Lindsay  brought 
in.   He  said,  "I'd  like  to  make  you  city  health  officer  of  New 
York."   He  said,  "Let's  talk  about  this  for  a  few  minutes,  and 
I'd  like  an  answer  by  tomorrow,  because  it's  yours,  if  you  want 
it." 

Crawford:   You've  already  started  here? 

Blum:      I've  started  here,  and  here's  Stanford,  here's  Los  Angeles  City 
and  County  and  now  New  York  City. 

Crawford:   All  these  things  coming  through! 
Blum:      Yes,  and  all  at  the  wrong  time. 

Crawford:   What  would  you  have  done  if  you  had  still  been  in  Contra  Costa 
and  all  these  offers  came  in? 

Blum:      I  couldn't  go  to  L.A.,  because  when  I  talked  it  over  with  my 
wife,  she  said,  "Look,  you  go  to  L.A.   I'll  stay  here." 
[laughter]   The  reason  I  said  I  would  be  willing  to  go  to  L.A. 
is  because  it  was  the  last  place  where  you  could  do  something. 
It  was  the  last  big  city  where  you  could  put  the  pieces 
together. 


244 


Crawford:   New  York  would  have  just  been  impossible? 

Blum:      Impossible.   It  went  downhill  for  the  four  preceding  and  all 
the  following  health  officers.   In  everything,  the  cards  were 
stacked.   The  unions  were  going  this  way,  business  was  going 
that  way.   L.A.  was  all  free-wheeling.   It  still  is.   Real 
estate  is  not  in  bed  with  the  church,  and  there  isn't  any 
church  to  be  in  bed  with.   San  Francisco  is  a  different  story. 
But  in  L.A.  the  movie  industry  doesn't  care  much  about  the 
airplane  and  manufacturing  business  or  the  real  estate  business 
or  agriculture;  all  of  these  are  free-floating  power  bases  and 
you  could  work  out  things  with  people. 

Crawford:   You  say  the  church  is  in  bed  with  real  estate  here? 
Blum:      That's  typical  San  Francisco. 
Crawford:   What  are  the  practical  ramifications? 

Blum:      Tremendous.   I  mean,  you  listen  to  what  the  unions  and 

Archdiocese  has  to  say  because  between  them,  they  have  all  the 
votes.   Down  in  L.A.,  it's  all  wide  open.   When  unions  or  real 
estate  or  electronics  promise  to  support  you,  you've  got  a 
vast,  free-floating  group  that  crosses  all  lines.   Ditto  for 
the  other  major  interest  groups.   It  really  would  have  been 
fun:  the  last  big  chance  in  the  U.S.  for  running  a  good  major 
city-county  health  department. 

Crawford:   Did  it  work  out? 

Blum:      Not  very  well.   They  got  very,  very  inadequate  people—just 

terrible.  The  new  big  boss  in  L.A.  is  the  last  health  officer 
from  Contra  Costa,  and  he  might  make  it.  He's  a  clever  guy,  a 
young  man. 

But  that  isn't  all.   This  is  in  the  course  of  maybe  two 
weeks  time.   Then  I  get  a  call  from  the  University  of  Hawaii, 
saying  that  they  need  a  dean  of  the  School  of  Public  Health  and 
the  state  also  needs  a  state  health  officer,  was  I  interested? 

So  I  come  trudging  home  each  night  with  all  this  wild 
stuff,  and  I  said,  "Well,  honey,  what  do  you  think  about  going 
to  Hawaii?"   "Live  on  an  island?"  was  the  response.   And  you 
could  just  see  in  her  mind  a  palm  tree  and  a  little  beach  and 
some  sand.   She  loves  it  for  a  vacation,  but  not  to  work  there. 

New  York  City—that  was  the  tough  one,  because  that  was  big 
bucks  and  great  visibility.   She  said,  "All  right,  now,  what  is 
it  about  New  York  that  would  really  be  so  wonderful?"   I  said, 


245 


"When  you  get  through  with  that,  you  are  well  known  and  nobody 
can  tell  fame  from  infamy  there.   So  however  well  you  do,  it 
doesn't  make  any  difference."   "And  so?"  Then  I  said,  "Well, 
then  I  can  get  any  job  I  want,  anywhere."  She  said,  "Such  as?" 
I  said,  "Well,  I  can  be  a  prof  at  UC  Berkeley."  She  said, 
"You've  got  to  be  crazy.   You  are  a  prof  at  UC  Berkeley." 
[laughter]   That  was  a  kind  of  irrefutable  position  or 
argument . 

So  when  it  all  wound  down,  the  only  thing  she  would  have 
put  up  with  would  be  to  go  to  Stanford,  if  that  really  worked 
out.   But  I'd  already  committed- -you  can't  leave  Berkeley  to  go 
to  Stanford  overnight. 

Chuck  Smith  obviously  wasn't  adverse  to  having  me  here, 
although  I  heard  from  various  sources  that  he  was  anti-Semitic. 
The  truth  of  the  matter  is  he  knew  very  well  that  I  was  Jewish, 
and  he  got  me  first  place  in  Contra  Costa,  where  there  were 
eighteen  or  twenty  candidates  and  some  very  good  people  with  a 
lot  more  experience  than  I  had;  and  he  got  me  first  place  in 
San  Mateo. 

He  was  just  a  nice  guy,  a  good  human  being.   I  have  trouble 
believing  that  he  was  anti-Semitic,  he  really  went  out  of  his 
way  to  get  me  started  careerwise.   He  was  still  here  when  I  was 
first  brought  on—that  was  not  as  a  tenured  professor.   In  any 
event,  Bill  Reeves  got  me  the  tenure  position  a  year  or  so 
later.   In  1967-68  I  was  half-time  full  professor  at  City  and 
Regional  Planning  and  half-time  here. 

That  was  a  start,  but  really  the  start  was  sidetracked  by 
the  campus  revolt  at  UC  Berkeley.   The  terrible  thing  was  that 
the  School  of  Public  Health  students  in  those  days  were  not 
very  socially  conscious,  and  they  said,  "Oh,  well,  let's  go 
home."   So  they  left,  the  bulk  of  them.   This  was  a  big  issue 
for  the  country,  but  not  for  them. 

Crawford:   It's  surprising  to  find  indifference  here. 


A  Joint  Masters  Program;  Department  of  City  and  Regional 
Planning  and  Health  Planning:  Collaboration  with  Nathan  Glaser 


Blum:      Yes,  it  is,  but  City  and  Regional  Planning  was  another  story. 
They  were  wide-eyed  and  ran  nearly  all  the  campus  protest 
activities  out  of  Wurster.   Practically  all  the  posters  were 
made,  and  all  the  key  student  meetings  were  held  there.   I  sat 


246 


Crawford: 
Blum: 

Crawford: 
Blum: 


Crawford: 


Blum: 


in  on  hundreds  of  student  and  faculty  meetings.   I  tell  you, 
that  was  big  business,  but  I  didn't  have  to  make  a  decision 
about  not  holding  class  —  there  was  nobody  left  to  hold  it  for 
in  public  health. 

And  how  long  was  that? 

Oh,  it  was  months  —  several  months.   The  whole  semester  was 
lost. 

What  was  the  job  in  environmental  design? 

That  came  about  because  I  was  teaching  health  planning  and  they 
wanted  to  keep  a  relationship  between  the  two  departments.   In 
fact,  I  later  engineered  a  joint  masters  degree  with  City  and 
Regional  Planning  and  Public  Health.   In  three  years,  a  student 
gets  two  masters  degrees  —  one  in  city  and  regional  planning, 
and  one  in  health  planning.   It's  an  ongoing  program.   It  made 
good  sense— there  were  a  lot  of  brilliant  people  in  city  and 
regional  planning,  both  on  the  faculty  and  among  the  students. 

Environmental  design  was  the  school,  and  this  was  the 
subset.   I  guess  I  taught  one  class  up  there  in  the  1970s,  and 
Bill  Wheaton,  who  was  head  of  the  department,  introduced  me  to 
the  class:  "This  is  Dr.  Blum.   He's  really  a  public  health 
person,  a  physician."   He  said,  "Now,  if  you're  going  to  be 
using  his  book  on  health  planning,  that's  the  best  book.   Well, 
it's  the  only  book."   [laughter]   He  wasn't  kidding  anybody.   I 
don't  think  he  was  overwhelmed  with  the  book,  although  I  was 
quite  pleased  with  it. 


This  was  Planning  for  Health  [Planning  for  Health. 
Publications,  New  York,  1974.) 


Behavioral 


Planning  for  Health.   So,  that  was  kind  of  fun.   At  that  point, 
Nathan  Glazer,  the  famous  sociologist  from  Harvard  of  Riesman 
collaboration  fame,  was  here  as  a  professor  in  city  and 
regional  planning.   It  was  that  kind  of  a  school.   They  had 
superb  people. 

William  Wurster  was  another  one—the  building's  named  after 
him- -he  was  both  the  dean  of  architecture  here  and  the  dean  at 
MIT  at  the  same  time  for  several  years.   It  was  a  nice  show. 
I've  mentioned  Mrs.  Wurster— her  name  was  Catherine  Bauer— was 
on  Len  Duhl's  Space  Cadets.   She  was  a  wonderful  person;  a 
sociologist  and  a  housing  expert. 

Nathan  Glazer  and  I  ended  up  in  the  same  enclave.   City  and 
regional  planning  decided  to  put  together  a  program  called 


247 


"social  planning."  There  wasn't  any  such  curriculum  then.   So 
Glazer  and  I  teamed  up  on  that,  and  we  actually  admitted  a 
group  of  doctoral  students  to  that  program.   It  was  really 
meant  to  be  Mel  Weber's  assignment,  but  he  was  on  a  sabbatical 
in  England.   He  was  teaching  over  there. 

So  Glazer  and  I  held  the  show  together,  admitted  a  dozen 
doctoral  students—some  became  quite  famous  —  and  I  learned  that 
part  of  Glazer 's  charm  was  to  let  the  other  guy  do  the  work, 
somehow  or  other.   He  was  a  brilliant  man,  and  as  soon  as  he 
saw  an  idea,  there  would  be  an  article  springing  out,  and  then 
it  was  published  because  he  was  Nathan  Glazer.   But  it  was 
quite  a  chore  for  me,  especially  as  he  got  really  fed  up  here, 
because  the  university  promised  him  this,  and  they  promised  him 
that,  and  produced  nothing.   He  was  supposed  to  have  a  decent 
office  and  a  secretary—he' s  kind  of  a  luminary,  you  know. 
Nothing.   So  he  went  back  to  Harvard.   I  gave  up  my  part-time 
work  at  city  and  regional  planning  since  I  had  to  do  a  full 
share  of  committee  work  for  each  of  the  two  departments  and  had 
no  time  left  to  do  anything  useful  in  either. 

Crawford:   What  about  the  rest  of  the  faculty  in  the  School  of  Public 

Health?   I  think  some  other  public  health  officers  were  brought 
on  about  the  same  time. 

Blum:      There  was  Dwight  Bissel,  but  he  was  never  full-time  faculty 
here.   He  was  one  of  the  people  who  competed  for  my  job  in 
Contra  Costa.   He  used  to  teach  here,  off  and  on.   He  was  a 
good  man--a  very  good  man—and  he  was  the  City  of  San  Jose 
health  officer.   But  he  was  filling  in  for  permanent  faculty 
that  the  school  didn't  have,  as  I  had  done  earlier. 

Then  Al  Leonard,  who  also  had  taken  the  exam  for  Contra 
Costa,  took  the  job  that  I  left  in  San  Diego  and  then  he  came 
to  be  the  City  of  Berkeley  health  officer.   At  that  time  the 
university  had  a  deal  with  the  City  of  Berkeley  that  three 
professors  in  the  School  of  Public  Health  would  also  be  the 
officials  of  the  health  department  of  the  City  of  Berkeley,  so 
that  we  would  have  a  real,  honest- to-God  training  ground  for 
public  health  students. 

In  any  case,  these  people  were  meant  to  be  both  in  teaching 
and  active  in  public  health  duties,  but  it  didn't  hold.   People 
like  myself  came  in  over  the  top  of  them  as  full-time  faculty, 
and  these  people  slowly  disappeared  from  the  faculty. 

One  of  the  catches  to  it  was  that  the  university  doesn't 
honor  people  who  are  doing  teaching  and  paid  work  for  cities 
and  not  devoting  themselves  to  research.   It  just  wasn't  in  the 


248 


cards  that  they  would  get  permanent  appointments  here,  even 
though  there  was  an  agreement  to  that  effect.   It  lasted  for 
half  a  dozen  years,  more  or  less. 


A  First  Course  in  Health  Planning.  1967.  and  New  Legislation; 
The  89th  Congress,  1966 


Blum:      I  came  here  in  July,  1966,  and  the  new  federal  planning  law  was 
passed  in  December,  1966,  and  I  decided  to  offer  courses  in 
planning  in  '67.   The  head  in  administration  was  Ned  Rogers  —  a 
very  lovely  Bostonian  and  just  a  terrific  guy--what  you  call 
an  honest,  bright  conservative  who  still  thought  the  Republican 
presidents  were  tremendous.   We  could  never  discuss  things  like 
presidents,  but  we  could  discuss  public  health,  and  he  wrote 
the  first  book  on  human  ecology. 

Crawford:   And  he'd  been  dean. 

Blum:      He  had  momentarily  been  dean.   He  brought  in  Smith  to  replace 
himself  when  he  was  about  to  become  UC's  vice  president  for 
health.   Because  he  had  the  temerity  to  say  publicly  that 
government  should  really  take  over  health  care,  the  medical 
people  in  this  world  wiped  him  out,  and  he  couldn't  be  a 
university  vice  president.   He  was  a  straightforward,  proper 
Bostonian,  a  Beacon  Hill-type  who  believed,  and  inadvertently 
said,  that  the  only  way  we're  ever  going  to  have  a  good  health 
care  system  is  by  the  single-payer  system—to  provide  universal 
coverage.   Well,  that  was  anathema  to  organized  medicine. 

Crawford:   How  did  they  move  against  him? 

Blum:      Politically,  they  just  saw  to  it  that  he  couldn't  be  vice 
president  for  health  at  UC. 


Blum:       So  Ned  Rogers  backed  away  and  said,  "Well,  Chuck,  1  brought  you 
in  to  be  dean,  you're  dean,  and  I'll  go  back  to  being  head  of 
administration,  a  professor  of  administration."  Not  too  long 
after  that  I  came  here,  and  when  Chuck  passed  away,  Bill  Reeves 
became  the  dean. 

Crawford:   Talk  about  the  difference  in  styles. 

Blum:      I  didn't  have  that  much  to  do  with  either  of  them  prior  to 

coming  on  full-time,  you  see.   As  I  said,  Chuck  Smith  was  very, 


249 


very  friendly,  and  he  was  good  about  human  beings.   One  of  his 
pet  students  became  the  health  officer  of  San  Mateo  County- -Hal 
Chope,  after  whom  they  named  their  county  hospital.   Chope 
caught  coccidioidomycosis  as  a  medical  student  in  Chuck  Smith's 
lab  at  Stanford.   It's  a  horrible  disease;  there  was  no 
treatment,  and  he  started  going  downhill.   So  Chuck  said, 
"Let's  just  never  mind  you  going  through  medical  school.  Let's 
have  you  take  it  easy."  They  sent  him  on  a  trip  around  the 
world.   Chuck  paid  for  all  of  this,  as  far  as  I  know. 

Crawford:   Just  felt  badly  about  it? 

Blum:      Yes,  and  I  think  Chope  wound  up  in  South  America,  where  he 

started  feeling  better.   He  came  back  and  he  was  all  right,  and 
he  finished  medical  school  and  went  into  public  health.   It 
takes  a  pretty  good  guy  to  accept  responsibility  for  such  a 
lab-acquired  illness.   Anybody  else  would  have  blamed  the 
student  for  breathing  too  hard,  or  something,  just  wouldn't 
take  it  upon  themselves—Chuck  did. 

Chope  and  I  were  co-partners  in  crime  for  many  years- -he 
was  health  officer  in  San  Mateo  County  and  I  was  in  Contra 
Costa.   He  was  a  good  bit  older  than  I  and  a  lot  more 
prominent.   In  any  event,  Chuck  took  a  hand  in  all  of  these 
things.   I'm  sure  he  took  a  hand  in  getting  him  that  job  in  San 
Mateo--which  was  the  best  public  health  job  in  the  States. 

Crawford:   I  talked  to  a  student  of  yours  from  those  early  years  named 
Lucy  Johns . 

Blum:      Oh,  wow.   Okay.   I  was  going  to  tell  you  about  Lucy. 

Crawford:   She  told  me  that  you  loved  the  climate  on  campus;  that  you  took 
courses  and  you  were  very  much  a  part  of  the  antiwar  activism. 

Blum:      Lucy  Johns  was  in  my  first  class,  and,  in  fact,  one  of  her 
ideas  was  in  my  first  book  on  planning.   Unfortunately,  I 
didn't  notice  that  when  it  was  published,  it  said,  "Lucy 
Jones, "  not  Johns.   It  was  one  of  those  nice  printer  errors. 
Lucy  upbraided  me  once,  in  recent  years  for  that.   She  said, 
"You  know,  I've  always  held  it  against  you  that  you  didn't  give 
me  credit  for  that  power  configuration." 

Crawford:   What  was  it,  specifically? 

Blum:      It's  a  chart  describing  sources  of  power  in  the  textbook  on 
health  planning  that  was  her  idea.   I  said,  "What  are  you 
talking  about?"  She  said,  "Well,  you  didn't  really  give  me 
credit."   I  said,  "Goddammit,  let's  get  a  copy  of  the  book." 


250 


So  we  opened  up  the  book,  and  I  said,  "Isn't  that  your  chart." 
"Well,  yes."   I  said,  "Well,  what  does  it  say?"  Then  we  both 
looked,  and  it  said  Lucy  Jones.   [laughter] 

She  had  never  bothered  to  really  look  at  that  chart.   I 
don't  know  what  she  thought  but,  any  event,  we  were  always  good 
friends.   She  was  in  my  first  class  of  graduate  students,  and 
she  was  a  character.   Sometimes  she  would  perch  up  on  my  desk 
in  my  office  and  start  giving  me  a  lecture. 

II 

Crawford:   You  must  have  had  wonderful  students. 

Blum:      Unbelievable.   They  were  very,  very  bright;  they  were  young; 
they  were  not  coming  here  for  refurbishing;  they  were  not  ex- 
health  officers  and  ex-this  and  ex-that,  coming  in  for  a  year 
so  they  could  get  a  raise  or  a  promotion.   These  were  people 
who  thought  something  could  be  done  and  should  be  done  by  use 
of  planning.   The  war  had  pretty  well  shaken  them  up.   We  were 
destroying  Johnson's  good  programs  to  create  an  army  to  kill 
all  the  Vietnamese  —  a  big  deal.   1  said,  "I've  never  taught  a 
planning  course."   "Well,  start .   Let's  start." 

Crawford:  It  sounds  as  if  the  students  contributed  substantially.  Lucy 
Johns  called  your  classes  a  free-for-all.  She  said  you  never 
stood  up  at  the  top  of  the  class  and  lectured  formally. 

Blum:      I  might  have  gotten  more  respect  if  I'd  have  done  that,  but 
then  I  probably  would  have  killed  the  discussion.   This  way, 
they  were  on  their  best  behavior  to  get  up  there  and  try  to  say 
something,  so  the  others  couldn't  demolish  it. 

Crawford:   You  had  more  Ph.D.  degree  students,  I  think,  than  anybody  on 
the  faculty. 

Blum:       I  probably  did. 
Crawford:   Were  you  tough? 

Blum:      No,  not  at  all.   I'd  inherited  a  good  many  from  other  faculty 
who  seemed  not  to  care;  wouldn't  even  read  their  students' 
papers.   We  had  a  few  such  faculty.   I  got  four  or  five  very 
good  students  who  had  a  faculty  member  who  wouldn't  even  read 
or  criticize  their  thesis.   I  remember  three  or  four—at  least 
two  of  whom  are  now  professors  —  that  I  just  took  over.   I  said, 
"Let's  change  the  committee  structure,  and  I'll  be  your 
chairman,  and  let's  get  rid  of  this  knothead  that  you've  got  in 
there  as  your  committee  chair." 


251 


Crawford:   You  mean  they'd  sign  off  without  having  looking  at  the  thesis? 

Blum:      Well,  they  might  not  even  sign  off.   They  might  not  ever  do 
anything—it  was  just  horrible.   There  weren't  a  lot  of  such 
people,  but  there  were  a  couple,  and  they  were  in  interesting 
slots,  so  the  students  were  attracted  to  them.   That  was  kind 
of  tragic. 

Crawford:  They  were  there  for  research  instead  of  teaching? 

Blum:  They  weren't  there  for  anything. 

Crawford:  Just  lazy? 

Blum:  Lazy  was  the  only  word  for  it. 

Crawford:  But  a  small  percentage,  let's  hope. 

Blum:      Yes,  but  they  were  agreeable  —  they '  d  take  any  student.   But 
then  they  wouldn't  even  read  a  thesis. 

I  inherited  a  lot  of  ambitious  people  who  came  in  with  an 
anthropologic,  sociologic,  or  economic  kind  of  slant,  a  lot  of 
whom  weren't  mine.   When  I  retired,  I  had  fourteen  people, 
still,  in  the  Ph.D.  track.   That  was  fine.   That  kept  me  doing 
something  for  several  years.   They  took  three,  four,  five 
years.   Many  of  them  were  working  full-time  as  well. 

Crawford:   So  that's  a  very  rewarding  aspect  —  it  has  to  be. 

Blum:      Yes,  and  people  don't  appreciate  that.   I  heard  the  old  saw 
about  faculty  who  have  to  publish  or  perish,  but  that  never 
bothered  me  as  I  started  out  at  the  top,  and  within  a  year  or 
two  I  was  tenured.   As  I've  said,  I  was  lucky. 

Crawford:   You  never  felt  pressured. 

Blum:      Pressured?  No. 

Crawford:   You  published  lots  after  that,  obviously. 

Blum:      Not  a  great  deal.   I  should  have  done  a  lot  more.   I've  got  a 

lot  of  things  I  really  could  have  published,  but  I  wasn't  quite 
secure  about  the  validity  of  my  observations,  for  instance, 
after  my  study  of  Sweden  in  1986.   I  did  more  work  on  Sweden 
than  anybody's  ever  done  from  this  country.   I  didn't  publish 
it  because  I  knew  there  were  a  lot  of  weak  spots  in  what  I  had 
put  together,  things  that  no  one  in  Sweden  was  prepared  to 
argue  or  defend.   It  was  good  enough  for  me  to  use  as  the  basis 


252 


Crawford: 
Blum: 


Crawford; 
Blum: 


of  lectures  and  classes,  but  we  weren't  drawing  absolute 
conclusions,  and  I  was  too  lazy  to  do  the  research  on  the 
thing,  especially  knowing  that  a  stranger  does  see  things 
differently,  not  necessarily  correctly  or  wrongly. 

This  was  true  of  my  trip  to  China  in  1987.   I  had  just 
finished  reading,  when  you  came  in,  a  thesis  on  health  care  in 
China.   It's  exactly  what  I  observed  in  1987  as  a  visiting 
professor  at  West  China  University  of  Medical  Sciences  in 
Chengdu,  but  I  never  wrote  a  word  on  it,  because  I  thought  that 
although  I  was  there  three  months,  I  had  pretty  superficial 
information.   I  didn't  really  document,  and  of  course,  neither 
did  they.   I  was  just  wandering  around,  looking,  talking,  and 
as  it  turns  out,  as  better  documentation  is  emerging,  I  was 
very  much  on  the  right  track  with  my  surmises,  e.g.,  that 
useful  basic  care  for  the  rural  800  million  was  falling  apart. 

Well,  this  is  a  masters  thesis  I  am  reading,  done  from  the 
literature,  but  it's  exactly  what  I  had  discovered.   It's  as  I 
thought  it  was--one  hell  of  a  mess,  and  it  all  started  just 
about  the  time  we  were  there.   I  never  published  a  word  on  it, 
because  I  didn't  want  to  badmouth  China.   I  didn't  know  where 
Deng  was  taking  them.   I  wasn't  about  to  spend  a  year  or  two 
researching  that.   Besides,  I  don't  speak  Chinese,  I  don't  read 
Chinese,  and  so  it  would  be  a  lot  of  second-hand  material.   I 
just  didn't  bother—but  in  my  own  mind,  I  saw  it  very  clearly. 
In  the  Swedish  situation  I  did  report  about  what  went  on  in 
Sweden,  and  contrasted  it  with  what  is  going  on  in  the  U.S.  so 
that  American  readers  would  have  a  baseline—but  never 
published  it. 

Yes,  we  have  that  material. 

I  think  it  was  pretty  good,  but  I  wasn't  that  interested  in 
publishing.   I  didn't  have  to  get  ahead.   I  did  it  for  my  own 
edification  and  for  the  students  that  I  was  working  with.   That 
was  good  enough,  but  some  of  the  faculty  feel  so  pressured. 
These  are  even  people  who  have  tenure  and  the  luxury  of 
everything—if  you  can  call  it  luxury,  being  around  here.   They 
really  weren't  interested  in  students;  that's  what  it  all 
boiled  down  to,  they  were  into  research. 

You  often  hear  that. 

The  one  thing  that  I  could  see  was  that  if  I  gave  three  hours, 
three  times  a  year— which  is  not  a  lot— to  some  good  doctoral 
student,  that's  about  what  it  took  to  help  them  when  they 
needed  it  on  their  thesis,  I  could  learn  a  lot. 


253 


Crawford:   Your  door  is  always  open,  even  now.   Dr.  Reeves  told  me  that. 

Blum:      Yes.   But  that  is  not  expensive.   I  mean,  three  hours  once  in  a 
while  for  somebody  digesting  the  world's  literature  on  a 
subject  and  doing  a  study  on  some  aspect  of  an  issue  gives  you 
the  last  word  delivered  to  your  desk.   Nobody's  going  to  do  it 
any  better.   It's  usually  something  new,  and  if  it  isn't 
something  new,  it's  a  repeat  of  something  old  that  needs 
repetition.   You  can't  complain  that  you're  losing  ground-- 
you're  not. 

Crawford:   Your  gain. 

Blum:      Yes,  for  a  few  hours,  you  get  what  people  have  spent  hundreds 
and  even  thousands  of  hours  on.   It's  true  that  many  faculty 
who  do  work  with  graduate  students  only  let  them  work  on  the 
area  that  they  themselves  are  working  in,  and  this 
distinguished  me--I  was  willing  to  have  the  student  work  in 
whatever  area  if  it's  relevant  to  the  student,  even  if  I'm  not 
getting  ahead  from  it. 

Crawford:   You'll  get  better  material  if  it's  their  real  interest  they  are 
researching  and  writing  about. 

Blum:      Well,  surely,  yes,  but  these  are  different  ways  of  looking  at 
it.  In  part,  I  never  had  any  pressure.   My  wife  and  I  had 
always  said  we  weren't  going  to  bend  to  pressure,  so  we  always 
saw  to  it  that  we  didn't  have  great  debts  and  we  always  had 
some  money  in  the  bank.   We  always  paid  for  our  houses  when  we 
walked  in  the  door.   We  were  not  born  rich,  I  can  assure  you, 
or  even  well-off  or  even  just  minimally  well-off;  we  were  in 
real  trouble  economically,  but  we  said,  "We're  never  going  to 
be  pushed  by  our  debts.   So  we  don't  have  to  accept  anything 
from  anybody  that  we  don't  want  to."  And  that's  a  great 
relief.   Now  it  does  mean  that  you're  stodgy,  in  one  sense, 
that  you  always  want  to  have  a  bank  account,  but  I  don't  find 
that  so  embarrassing. 

But  I  learned  a  lot  and  I  took  fourteen  or  so  Ph.D.'s  on 
after  I  retired. 

When  I  retired  from  the  School  of  Public  Health  at  the  end 
of  1984,  there  was  a  huge  party--!  mean,  hundreds  of  people 
from  all  over,  and  there's  a  picture  of  me,  six  months  old- -my 
wife  had  fetched  it  out- -stark  naked,  you  know.   [laughs] 

Crawford:   Oh,  they  loved  that. 


254 


Blum:      And  they  blew  it  up.   It  was  six  feet  high.   I  found  it  the 
other  day,  or  she  did,  cleaning  out  my  study  closet. 

So  it  was  that  sort  of  a  thing;  my  whole  career  laid  out, 
and  people  wanted  to  say  things.   The  major  speaker  was  Bill 
Reeves,  but  Lucy  Johns  wasn't  on  the  list  to  say  anything,  and 
she  just  worked  herself  right  up  to  the  microphone,  and  got  a 
little  hysterical—that's  not  Lucy's  style—about  how  I'd  saved 
her  life,  and  her  career,  and  a  few  other  things.   She  was  one 
of  the  protesters  in  '67,  in  that  first  class.   Lucy  had 
wandered  around  with  some  kind  of  a  sign  about  something  or 
other,  and  lo  and  behold,  had  been  nailed  and,  apparently, 
kicked  out  by  Chuck  Smith.   I  don't  really  remember  all  this, 
neither  does  Bill  Reeves. 

Crawford:   That  was  the  situation  on  campus? 

Blum:      Oh,  it  was  pretty  mean,  yes.   I  found  out  whatever  the  matter 
was  and  got  her  back  in.   She  was  probably  the  best  student  I 
had.   It  was  just  absolutely  an  amazing  planning  class,  almost 
every  one  of  them  became  well-known  at  whatever  they  were 
doing. 

That  was  a  class  that  insisted  that  we  teach  planning 
because  they  all  came  for  that  purpose,  but  there  was  no 
planning  program  or  courses  as  yet,  and  it  was  my  first  year  of 
full-time  teaching.   So  we  struck  up  a  deal.   There  were  about 
thirty  students  who  wanted  to  take  planning,  and,  if  each  of 
them  promised  to  do  a  lecture,  then  I  would  run  the  course.   I 
agreed  to  give  one  lecture  too.   We  had  divvied  up  issues  of 
different  kinds  that  none  of  us  knew  about,  because  planning  is 
not  the  public  health  world.   It  wasn't  then,  and  it  still 
isn' t . 

Crawford:   So  the  demand  was  coming  from  the  students? 

Blum:      Yes.   As  I  said,  I  was  hired  as  a  professor  of  administration, 
and  at  that  moment  they  didn't  need  me  in  that  area.   They  had 
several  good  people  here,  and  there  was  nothing  left  for  me  to 
teach,  so  I  was  going  to  sit.   I  remember  coming  to  the  first 
faculty  meeting,  and  they  asked,  "What  do  you  want  to  do?"   I 
said,  "There  will  be  a  planning  law  in  a  couple  of  months- - 
maybe  I  should  teach  planning."  They  agreed  that  it  was  a  good 
idea.   They  said,  "There's  nobody  here  to  teach  planning,  and, 
besides,  everybody  in  public  health  knows  how  to  plan."  Which 
was  surely  a  good  joke,  as  it  turned  out.   So  I  agreed  to  do 
it,  and  I  had  this  first  class,  which  probably  was  January  of 
'67,  and  Lucy  was  in  that  group,  along  with  some  other 
unbelievable  people. 


255 


Crawford: 
Blum: 

Crawford: 


I  had  been  to  a  meeting  a  few  months  before  the  course 
started  and  ran  into  a  man  by  the  name  of  Mark  Blumberg,  who 
became  chief  planner  for  Kaiser.   He  was  probably  the  first 
bonafide  health  planner  in  the  United  States.   Mark  Blumberg- - 
he  was  a  dentist,  a  physician,  and  an  economist  —  and  just  a 
tremendous  person.   He  did  some  of  the  first  technical  health 
planning  in  the  U.S.,  in  Hawaii  on  their  health  plan,  and  put 
them  way  ahead  of  everybody.   Nobody  knew  what  it  was  that  he 
was  doing  at  that  time,  but  it  was  good,  and  became  a  landmark 
approach  to  one  area  of  planning. 

I  think  he  and  I  had  worked  together  at  that  air  pollution 
control  district  —  that  little  advisory  committee— and  Mark  was 
either  part  of  the  staff,  or  he  was  on  the  technical  advisory 
board.   I  left  about  the  time  he  came  on.   Maybe  he  replaced 
me .   I  don ' t  know . 

A  few  months  before  my  first  planning  course  got  underway, 
he  and  I  were  at  a  meeting  on  manpower,  and  he  gave  a  spiel 
about  what  was  wrong  with  the  document  that  had  been  presented 
to  us.   I  had  exactly  the  same  feelings  about  it,  and  expressed 
them.   After  that,  he  came  up  to  me,  and  he  said,  "What  the 
hell  do  you  know  about  planning?"   He's  that  kind  of  a  guy,  a 
really  big,  tall  gruff  guy.   I  said,  "Oh,  enough  to  be  a 
professor  of  health  planning."   He  had  never  been  a  professor, 
and  I'm  told  that  he  always  wanted  to  be,  and  that  remark  was 
the  worst  kind  of  beating  anybody  could  have  given  him.   He's  a 
very  helpful  man,  as  well  as  a  wonderful  planner. 

So,  since  we  were  getting  acquainted  the  hard  way,  I  said 
to  him,  "Look,  I'm  going  to  start  teaching  a  course  on  health 
planning.   How  about  you  coming  over  and  opening  it  up,  and 
setting  us  straight.   Explain  planning  to  us,  because  I'm  not 
so  sure  we  know  what  it's  about."   He  did  that  and  came  here 
for  years.   He  used  to  assist,  come  in,  wouldn't  take  any 
money.   He  was  at  Kaiser  and  couldn't  receive  money.   Mark 
started  us  off,  and  then  each  of  the  students  took  a  subject;  I 
took  one,  and  we  explained  to  one  another  what  these  terms  and 
concepts  were  that  were  central  to  planning  and  that  we  had 
never  dealt  with  in  public  health.   So  the  course  started  out 
with  a  bang. 

What  was  the  thrust  of  the  course? 

Planning— health  planning- -what  it  was,  how  to  do  it.   It  ended 
up  being  a  great  big  book  in  my  hands  before  it  was  all  done. 


Different  kinds  of  health  planning? 
that  sort  of  thing? 


Single  payer  coverage, 


256 


Blum:  No.  We  were  in  the  world  of  health  planning,  not  health  care. 
My  attitude  was  that  you  have  to  plan  for  health  care  when  you 
fail  on  the  health  planning  side,  that  what  doctors  do  is  just 
treatment  for  health  failures. 

Health  planning  really  has  something  to  do  with  "Do  you 
have  something  to  eat?  Do  you  have  a  job?  Do  you  have  a  roof 
over  your  head?  Do  you  have  rats  enjoying  it  with  you,  or 
not?"  This  is  what  affects  health;  this  is  the  big  game.   The 
world  is  coming  back  to  it,  finally.   The  realities  are  that 
health  is  determined  primarily  by  the  large  environment, 
social,  cultural,  economic,  educational  forces  in  particular. 
So  that's  what  the  students  were  learning.   Ultimately  many  of 
them  ended  up  doing  health  care  planning  too. 

Crawford:   What  was  the  legislation? 

Blum:      Oh,  it  was  the  Public  Law  89-749--the  89th  Congress. 

Crawford:   You  said  that  became  law  just  as  you  were  coming  on  at 
Berkeley. 


A  1968  Planning  Grant  from  the  USPHS ;  a  Program  for  Minorities 
and  Native  Americans;  Abandoning  Our  Marvelous  Planning  Grant 


Blum:      Yes.   We  knew  it  was  going  to  happen,  and  nobody  in  the  United 
States  or  anywhere  else  knew  where  or  how  to  start  teaching 
about  it.   So  we  started  right  here,  and  we  had  a  good  time. 
We  got  a  huge  grant—Bill  Reeves  was  already  dean--and  we 
started  out  educating  ourselves. 


Blum:      In  the  School  of  Public  Health  we  did  assemble  a  team.   It  was 
very  clear  where  the  health  problems  were  —  they  were  primarily 
in  the  poor  and  dysfunctional  neighborhoods.   So  we  started  the 
planning  program  here  by  bringing  in  forty  or  fifty  of  the 
world's  top  planners  in  the  summer  of  1968  to  teach  us  what 
planning  was  and  how  to  go  about  it. 

One  of  them  came  from  Cleveland,  which  supposedly  had  done 
the  very  best  work  on  health  planning.   They  have  a  good  school 
of  planning  in  Ohio,  interestingly  enough.   I  think  it's  the 
Hoover  School  at  the  University  of  Cincinnati.   I  remember  I 
visited  there  once.   Cleveland  had  this  great  study  about  what 
to  do,  and  if  you  flip  over  the  pages  of  the  report,  the  first 


257 


thing  you  see  is  where  the  problems  are.   The  problem  areas 
were  shown  in  transparencies,  and  on  the  very  bottom 
transparency  was  the  census  tracts.   On  the  next  overlay 
transparency  was  the  average  incomes.   Then  came  all  the  health 
pictures.   All  the  bad  health  problems  in  Cleveland,  by  and 
large,  were  in  a  handful  of  neighborhoods;  you  could  see 
through  all  these  transparencies  —  all  were  in  the  same  place. 

Cleveland  had  brought  in  the  greatest  minds  in  public 
health  and  that  was  part  of  this  great  Cleveland  Plan.   They 
looked  at  the  study  and  they  said,  "Well,  we  have  to  have 
better  sex  education.   We  have  to  have  more  blood  testing." 
They  looked  at  the  infant  death  rates,  and  they  said,  "We  have 
to  have  more  clinics  to  give  earlier  prenatal  care."  All  in 
the  bad  neighborhoods. 

They  went  through  every  one  of  these  major  health 
deficiencies  and  came  up  with  all  the  answers  that  never  have 
worked- -and  that  was  the  great  Cleveland  Plan.   We  learned  how 
incompetent  health  planners  really  were  and  how  ignorant  public 
health  specialists  were. 

Crawford:   What  is  the  problem  with  it? 

Blum:      The  study  tells  you  exactly  what's  wrong,  and  that  nobody  gives 
a  damn  about  the  causes.   They  went  through  all  the  traditional 
markers  for  health  and  produced  all  the  recommendations  that 
don't  make  that  much  difference.   They  acted  as  though  treating 
each  of  the  findings  by  traditional  health  care  and  education 
was  going  to  offset  the  illiterate,  poverty-stricken, 
dysfunctional  neighborhoods  and  families. 

Crawford:   Instead  of  getting  to  the  neighborhoods--. 

Blum:      And  seeing  how  you  could  revive  them.   But  we  were  educating 

ourselves,  and  that's  when  we  invited  all  these  people  in,  and 
it  was  kind  of  dispiriting  to  see  how  stupid  some  of  the 
renowned  experts  really  were.   None  of  the  professional 
planners  were  making  a  case  for  looking  at  anything 
intelligently.   The  Cleveland  Plan  was  great  —  tremendous,  but 
it  was  irrelevant.   Even  heart  disease,  even  cancer,  accidents, 
all  diseases  were  excessive  in  the  same  neighborhoods,  how  can 
one  overlook  the  socio-economic  cultural  setting? 

Well,  people  are  still  getting  famous  for  writing  about 
that  and  using  those  data— some  to  illustrate  what  is  really 
relevant,  and  some  to  go  back  to  the  old  garbage.   The  United 
States  Public  Health  Service  still  deals  mostly  with  the  old 
garbage— even  the  Robert  Wood  Johnson  Foundation  in  one  of 


258 


their  1997  brochures  regurgitates  how  it's  just  bad  habits  that 
are  killing  Americans. 

II 

Blum:      As  an  aside,  there  had  been  practically  no  minority  students 
here  before  that.   Yes,  there  were  people  who  were  black  or 
blue  or  green,  but  that's  because  they  came  from  other 
countries  to  get  their  schooling  here. 

So  we  started  out,  and  one  of  the  people  in  that  first 
class  was  an  exec  from  the  TB  circuit,  Elaine  Walbrook.   She 
was  in  my  first  class  when  I  was  new  here,  and  she  was  new  as  a 
student,  but  we  had  become  old  pals  in  previous  years.   Since 
I'd  lost  track  of  her  in  the  TB  movement,  she  had  gone  to  work 
for  the  Paiute  Indians  in  Nevada.   She  was  in  the  class,  and  as 
we  put  the  grant  together  I  grabbed  her  to  be  part  of  the  staff 
because  she  was  an  expert  organizer. 

Crawford:   This  was  a  U.S.  Public  Health  Service  grant  in  curriculum 
planning? 

Blum:      A  planning  grant. 

Crawford:   A  hundred  and  six  thousand,  something  like  that? 

Blum:      Oh,  hell  no.   It  was  a  million  and  a  half  or  something  like 
that. 

Crawford:   For  Berkeley?  That's  astounding. 

Blum:      Well,  there  was  no  school  in  the  country  that  was  prepared  to 
deal  with  it  but  Berkeley's  School  of  Public  Health. 

Crawford:   Those  were  the  salad  days? 

Blum:      Yes,  there  was  money.   Lots  of  money  has  been  wasted  on  a  lot 
of  other  things,  too. 

Crawford:   Was  that  a  multi-year  grant? 

Blum:      Yes,  it  was  for  three  years.   Elaine  had  the  idea  to  bring  in 

minorities  in  the  summertime  for  the  six-week  summer  portion  of 
the  grant  program  and  teach  them  something  about  health 
planning.   We  decided  to  bring  in  a  lot  of  black  people  for  the 
first  summer,  because  they  were  the  most  numerous  around  us. 
Then  the  second  year,  we  would  bring  in  a  good  number  of 
American  Indians—who  were  her  buddies  —  and  she  knew  their 
world  backwards  and  forwards.   The  third  year,  we  would  bring 


259 


Crawford: 
Blum: 


in  Hispanics--they ' re  the  most  recent  immigrants, 
exactly  what  we  did. 


And  that ' s 


We  had  a  tremendous  experience,  and  not  just  because  we 
brought  in  guest  lecturers.   We  started  in  the  spring  of  '68 
with  ourselves  and  guest  artists  for  us,  and  by  the  time  we  got 
to  the  summer,  we  realized  that  we  were  hearing  nothing  new, 
practically.   Everything  we  were  going  to  hear,  we'd  boned  up 
on.   In  a  year  I'd  read  about  three  hundred  books  on  planning-- 
I  really  mowed  through  the  field.   I  discovered  that  we  in 
public  health  knew  nothing  about  it.   The  planning  that  one 
does  in  administering  an  organization  has  little  to  do  with 
community- level  planning.   It's  a  different  world. 

Define  what  you  mean  a  little  more  narrowly,  would  you? 

Well,  if  you  work  inside  an  organization,  you've  got  the 
organization's  objectives,  and  you've  got  the  rules  of  the  game 
by  which  it  must  work,  and  a  set  budget  with  which  to  do  it. 
This  is  what  is  wanted  from  it,  so  how  do  we  get  from  here  to 


there  with  the  monies  we  have, 
almost  automatic. 


It's  internal  planning.   It's 


Crawford: 
Blum: 


In  other  words,  that's  what  everybody  is  getting  so  famous 
for,  guiding  their  organization,  and  getting  their  hundred 
million  dollars  of  bonus  for.   You're  going  from  here  to  there, 
but  you  have  to  figure  out  how  to  do  it- -but  it's  all  cut  and 
dried  when  it's  within  your  organization,  e.g.,  make  a  handsome 
profit.   Once  you  make  your  plan,  whether  you  were  wise  or  not, 
time  will  tell.   But  when  we  were  doing  health  planning,  we 
were  planning  for  whole  communities  rather  than  for  an 
organization,  and  we  had  to  take  everyone's  objectives  into 
account,  various  levels  and  types  of  government  agencies  and 
the  whole  world  of  private  interests,  as  well  as  the 
unexpressed  needs  and  desires  of  the  citizenry  whose  health  is 
to  be  improved. 

Global. 

Yes,  in  other  words,  what  is  needed  here?  This  is  a  view  that 
can  be  shared  by  every  citizen,  if  you  want  to  go  that  far. 
There  is  also  a  special  set  of  constraints,  as  no  two  people 
need  or  want  the  same  things.   It's  just  a  different  world—and 
it's  a  fun  world—it  isn't  just  internal  organizational 
planning.   Not  everybody  understood  this,  and  some  people  in 
public  health  never  did. 

So  we  started  out  teaching  ourselves,  and  within  six 
months'  time,  we  had  a  pretty  good  understanding  of  the 


260 


subject.   Then  we  invited  in  these  minority  people,  along  with 
others,  for  a  six-  week  summer  session.   We  had  folks  from  all 
kinds  of  out-of-the-way  places,  such  as  the  Pacific  Islands. 
We  brought  in  lots  of  minority  people  who  ultimately  went  on  to 
graduate  school,  and  a  good  many  for  more  advanced  degrees. 
They  had  been  proposed  by  their  communities  generally. 

II 

Blum:      Unfortunately,  our  concern  for  planning  for  improved  health  did 
not  focus  on  how  to  do  more  or  better  medical  care,  rather  on 
how  to  improve  health  by  working  on  the  socioeconomic  and  other 
factors  that  determine  health.   This  scared  our  funders.   At 
the  end  of  the  second  year  they  adjourned  a  spectacular  team  of 
over  a  dozen  hot-shots  of  traditional  fame.   After  a  day  of 
questions  and  answers  down  in  the  then  Regents'  meeting  room  on 
the  ground  floor  of  this  building,  they  remained  totally 
nonplussed,  best  expressed  by  one  of  the  visiting  geniuses, 
"Why  don't  you  build  something  useful  like  planning  a  health 
center,  rather  than  working  on  how  to  prevent  the  various  major 
forms  of  heart  disease?"   I  lost  my  cool  and  suggested  that 
we'd  rather  use  our  wits  and  no  money  than  their  wits  and  their 
money,  a  sort  of  Shavian  take-off. 

As  we  walked  out,  someone  came  up  behind  me.   It  was  Bill 
Reeves,  whom  I  hadn't  seen  come  in  the  back  door,  and  he  said, 
"I  guess  you  don't  really  want  your  grant  —  good  for  you,  keep 
on  doing  what  needs  to  be  done."  That  was  mighty  supportive 
from  the  dean  at  a  bad  time. 

We  had  done  the  right  thing  and  went  on  our  way.   They  let 
us  spend  what  remained  of  the  grant. 


Blum:      Planning  became  big  time,  even  without  our  grant,  and  Elaine 
Walbrook,  because  she  identified  with  the  Indians,  took  their 
recruitment  on  after  the  big  grant  was  over,  and  we  really 
brought  in  Native  Americans  to  UCB  for  years  and  years  and 
years;  brought  them  in  first  to  Public  Health  and  to  Social 
Welfare,  then  to  the  whole  campus.   Elaine  was  the  brain  behind 
this. 

When  you  come  to  our  house,  you  see  a  lot  of  Indian  things. 
These  are  gifts  from  ex-students;  people  that  went  through  the 
program.   They  had  an  interesting  time.   I  remember  one  lady, 
Sandra  Yellowhawk,  gave  me  a  beautiful  burden  basket.   She's  an 
organizer,  down  in  Peach  Springs,  of  all  places  —  that '  s  the 
entryway  to  Havasu  Canyon.   She  was  a  very  quiet,  soft-spoken 


261 


person—trained  as  a  nurse.   After  the  first  year—it  was  a 
two-year  program— she  introduced  me  to  her  husband  and  daughter 
one  day,  and  she  said,  "I  know  you  wouldn't  approve  of  what  we 
did,  but  my  daughter  and  I  just  went  to"— what  was  the  name  of 
that  great  big  faker  who  held  those  horrible  meetings  and 
taught  you  how  to  be  a  bastard  to  everybody? 

Crawford:   Werner  Erhardt— est . 

Blum:      Werner  Erhardt— est .   She  said,  "I  know  you  wouldn't  approve  of 
it,  but  we  went."  She  never  spoke  like  this  before.   She  said, 
"You  know,  I  don't  think  my  daughter  and  I  ever  had  a 
conversation  before  we  went  to  this  course,  and  my  husband  and 
I  surely  never  did.  We  just  sat  there  and  ate  our  breakfast, 
and  our  lunch,  and  our  dinner.   We  never  really  conversed  with 
one  another.   Now  we  do."   She  joined  the  graduation  committee 
of  the  School  of  Public  Health,  and  she  got  into  every  single 
thing  before  the  year  was  over— she  just  blossomed. 

Crawford:   She  was  empowered,  as  they  say. 

Blum:      Empowered.   And  by  that  reprobate.   Well,  we  had  all  kinds  of 
people,  and  some  did  have  trouble.   We  brought  in  a  wonderful 
old  medicine  man,  and  he  had  a  bad  time  because  this  was  so 
foreign,  and  he  was  an  old  man.   Many  of  these  people,  when 
they  went  back  to  their  tribes,  were  resented  and  pushed  out. 
It  was  like  the  old  story  of  the  Africans  going  back  to 
Liberia:  "We  don't  need  you;  you're  not  one  of  us."   So  there 
was  some  of  that. 

We  had  one  wonderful  guy,  since  passed  away,  who  was  a 
robust  Midwest  Indian.   He  was  a  fighter  pilot  during  World  War 
II,  and  a  hereditary  chief.   Some  of  the  tribes  have  hereditary 
chiefs,  some  have  elected  chiefs,  and  some  don't  have  chiefs  at 
all,  like  the  Navajos.   He  came  through  the  summer  training 
program,  and  he  did  very  well,  though  he  used  to  give  us  a 
rough  time.   He  was  a  burly,  fun  kind  of  character. 

Elaine  set  up  an  Indian  advisory  board  for  the  whole  Indian 
recruitment  and  training  program  that  we  ran.   All  this  had 
merged,  finally,  into  just  an  Indian  program,  because  black 
recruitment  and  Hispanic  took  place  elsewhere.   The  advisory 
board  was  made  up  of  prominent  Indian  leaders  from  many  walks 
of  life,  including  some  of  our  former  summer  trainees  as  well 
as  Indian  graduates  from  our  school.   They  advised  us  on  the 
real  world,  on  what  we  had  to  teach,  and  helped  get  legislation 
and  funds  relevant  to  our  training  and  relevant  to  Indian 
health  generally. 


262 


Crawford: 
Blum: 


The  hereditary  chief  came  on  the  board  a  few  years  along, 
and  as  I  greeted  him  he  made  a  little  speech  to  the  board  for 
my  benefit  to  the  effect  that  I  had  been  so  patronizing  to  the 
Indians  in  the  summer  program,  and  it  made  him  decide  to  show 
me--he  went  to  Harvard  and  got  an  M.B.A.,  and  then  went  back  to 
his  tribal  chief  duties,  and  here  he  was  on  our  board,  back  at 
UCB.   He  had  forgiven  me,  decided  I  was  all  right  after  all. 

Elaine  did  so  well  that  we  recruited  Indians  for  eight 
other  schools  of  public  health,  as  well  as  our  own.   We'd  give 
the  trainees  a  summer  training  here,  and  then  they'd  go  to 
whatever  school  they  had  chosen.   We  had  big  grants  in  order  to 
keep  going.   Elaine  did  all  that  single-handed.   She  knew 
Senator  Fred  Harris,  who  was  married  to  a  great  Indian  lady. 
Elaine  really  knew  everybody  in  the  field  and  on  the 
congressional  committees. 

Then  the  Indian  Health  Service  started  fighting  us.   You 
see,  we  had  said  we  would  not  train  people  just  to  go  back  to 
the  Indian  Health  Service.   There  was  no  way  Indians  were  going 
to  get  a  masters  degree  here  and  just  qualify  for  the  Indian 
Health  Service.   You  come  here  as  an  Indian,  you're  not  going 
out  as  an  Indian- -you1 re  going  out  as  any  damn  thing  you  want. 
They  couldn't  understand  that,  and  they  didn't  want  to  put 
money  into  it.   One  of  the  SPH  non-Indian  graduates,  actually, 
ran  the  IHS  program.   We  fought  him  tooth  and  nail  in  Congress 
and  won,  year  after  year.   Elaine  was  hated  in  some  quarters, 
but  she  did  the  job  and  was  loved  in  the  Indian  community. 

Were  they  generally  successful  in  their  fields? 

I  would  think  so,  yes,  and  we  have  some  wonderful  memories  of 
some  of  those  people,  some  of  whom  I  still  occasionally  see. 

The  upshot  of  all  of  this  was  that  we  won  the  battle  year 
after  year  of  getting  the  funds  for  the  Indians,  in  spite  of 
the  Indian  Health  Service.   Elaine  passed  away  a  few  years  ago 
from  cancer,  which  had  limited  her  for  several  years,  but  she 
never  quit.   She  carried  the  ball  on  this  campus. 

We  had  social  welfare  involved,  and  then  we  sat  down  with 
the  dean  for  minority  affairs  and  the  folks  in  engineering; 
some  petroleum  types.   They  said  they  didn't  want  any  Indian 
programs,  unless  the  students  could  get  in  on  the  usual 
admission  procedures,  and  so  on. 

Elaine  looked  at  this  great  professor,  and  she  said,  "Where 
do  you  work?  Don't  you  work  with  Conoco?  Do  you  know  you're 
on  Navajo  land?  Do  you  realize  that  they  govern  this  land?" 


263 


She  really  slapped  him  around,  and,  lo  and  behold,  engineering 
decided  they  could  take  Indians.   Some  of  the  students 
graduated  here  and  then  went  through  law  school  as  well. 

There  was  another  Indian  graduate  of  this  school  of  public 
health  years  and  years  ago—Blue  Spruce.   George  Blue  Spruce 
was  an  Indian  dentist,  of  which  there  are  very  few,  and  he  had 
graduated  here  and  had  gone  on  to  be  a  big  shot  in  the  Indian 
Health  Service.   Such  Indians  were  rare  until  our  program 
kicked  in. 

I  hadn't  been  here  very  long  when  I  got  the  bug  that  we 
should  have  minority  students  in  the  department.   In  Contra 
Costa  County,  we  had  worked  with  all  kinds  of  wonderful 
minorities.   There  were  people  who  were  talented,  yet  said  that 
they  could  never  make  it  into  this  university  and  so  on.   It 
seemed  preposterous,  but  many  of  them  didn't  bother  studying  in 
school,  and  I  knew  that.   So  I  cooked  up  a  deal. 

I  wanted  nineteen  or  twenty  new  student  slots,  one  for  each 
program—there  were  that  many  programs  in  the  School  of  Public 
Health,  and  everybody  who  had  a  grant  had  a  program.   They  were 
departments  unto  themselves,  and  it  was  a  mess. 

Crawford:   What  would  have  been  some  of  those  categories? 

Blum:      Oh,  there  might  be  maternal  and  child  health,  there  might  be 
nutrition—those  are  the  big  ones— health  education,  but  then 
there  was  nursing  administration,  there  was  hospital 
administration,  there  was  dental  administration,  there  was 
general  administration,  there  was  planning.   There  were  five 
programs,  right  in  that  one  little  enclave  of  administrative 
thinking,  each  admitting  their  own  students. 

Crawford:   All  competing  for  the  same  funding? 

Blum:      Not  quite;  there  was  different  funding.   The  reason  they  were 
in  existence  was  that  each  had  different  specialized  funding. 
This  was  the  heyday  of  the  School  of  Public  Health  fundings, 
but  not  too  academically  healthy. 

Crawford:   Why  was  funding  so  easy  to  come  by? 

Blum:      Well,  this  was  the  Johnson  era.   They  were  trying  to  do 

something,  trying  to  change.   After  all,  the  U.S.  was  a  pretty 
chronically  impoverished  place.   It  may  have  looked  good  in  San 
Francisco,  but  it  didn't  look  so  good  in  a  lot  of  other  places, 
including  the  hills  of  California.   Hillbillies  were  indigenous 
out  there,  all  kinds  of  them. 


264 


Crawford; 
Blum: 

Crawford: 
Blum: 


Crawford: 
Blum: 
Crawford: 
Blum: 


So  I  decided  to  go  for  a  minority  training  grant.   I  wrote 
it  up  and  took  it  around  to  each  of  the  faculty,  and  I  said, 
"Just  put  up  one  slot.   Make  a  provision  for  one  student,  one 
minority,  and  between  us,  we'll  have  twenty."  Do  you  know,  not 
a  single  department  would  give  me  one  slot. 


A  student  slot? 

A  student  slot, 
was  one. 


Not  a  single  department  except  mine,  so  there 


What  would  it  have  cost  them? 

Nothing,  they  just  weren't  about  to  put  up  with  that  kind  of 
nonsense.   They  were  going  to  pick  all  the  best  students  they 
could  get,  and  had  no  room  for  a  minority  person  who  might  not 
seem  up  to  the  grade-based  competition. 

So,  was  this  anti-affirmative  action? 

Oh,  yes,  and  I  realized  it  wasn't  going  to  get  any  better. 

How  about  Dr.  Reeves? 

Well,  he  was  the  dean,  so  I  took  it  down  to  him.   I'd  never 
talked  to  him  about  this,  and  I  didn't  know  what  to  expect.   I 
knew  he  was  a  nice  guy,  and  I  knew  he  liked  me  because  he  was 
the  one  who  made  me  a  tenured  professor.   In  those  days  there 
were  no  committees—you  just  did  it. 

He  said,  "You're  going  to  take  in  nineteen  or  twenty  people 
because  they're  black  or  brown  or  something,  and  you're  going 
to  leave  out  people  with  straight  A's  from  Harvard?"   I  said, 
"I  don't  expect  to  leave  anybody  out  who  has  straight  A's  from 
Harvard,  but  it  might  be  good  for  the  school  to  leave  them 
out."  We  had  had  some  horrible  people  from  those  great  places. 

I  said,  "These  are  the  people  who  come  from  the  ranks  of 
the  folks  who  need  the  services,  and  we  graduate  nobody  to  talk 
to  them  out  there."  This  is  a  very  basic  argument  about 
diversification.   We  had  quite  a  time,  and  then,  without 
batting  an  eyelash—typical  Bill  Reeves--he  said,  "All  right. 
What  do  you  want  me  to  sign?"   [laughter] 

So  he  signed  the  document  asking  for  the  assignment  of 
nineteen  or  twenty  new  student  positions  in  the  school, 
positions  which  are  fought  over  because  student  slots  are  the 
basis  for  getting  more  faculty—it 's  all  geared  to  student 
enrollment,  you  see. 


265 


Then  I  took  this  up  to  the  dean  of  the  graduate  school,  who 
I've  mentioned  was  a  fine  man  by  the  name  of  Sanford  Elberg. 
Sanford  is  still  around.   He  used  to  be  faculty  at  the  School 
of  Public  Health.   He  was  the  world's  authority  on  brucellosis. 

He  had  been  one  of  my  instructors  in  bacteriology;  we  hit 
it  off  really  well,  because  I  had  made  a  point  of  being  the 
best  student  in  the  big  course  in  bacteriology. 

fl 

Blum:      He  looked  at  the  document  and  agreed  that  it  was  very 

important.   He  said,  "Let's  go  into  the  inner  office  and  talk 
about  it."  Then  he  gets  to  the  inner  office,  which  was  all 
fitted  in  oak,  pulls  open  the  drawer  behind  him,  and  brings  out 
a  big  flask  of  sherry.   He  pours  me  a  glass  and  pours  himself  a 
glass.   [laughs]   This  isn't  customary  behavior  on  this  campus, 
I'll  tell  you. 

We  start  discussing  the  proposal,  and  we  go  through  the 
various  aspects  of  it.   I  wanted  these  graduate  level  slots  to 
be  free  of  the  college  B-average  requirements,  so  that  the 
students  could  come  in  with  less  than  a  B  average  if  they  met 
certain  other  criteria. 


Crawford; 
Blum: 


He  said,  "Well,  I'll  take  it  under  advisement."   I  knew  it 
was  probably  like  birth  control  in  the  health  department  —  it 
ain't  done.   You  just  don't  ever  drop  the  B  average  for 
minorities,  which  you  do  all  the  time  for  football  players  and 
basketball  players,  artists  and  others,  and,  I  suspect, 
occasionally  for  the  governor's  son  or  daughter,  but  I  don't 
know  that.   I  have  just  heard  more  about  this  recently. 

I  get  a  letter  a  week  or  so  later  in  which  Sanford  starts 
out  by  indicating  one  of  the  problems  with  it,  and  then  another 
problem,  then  another  problem,  and  another.   I  thought  he  was 
going  to  let  me  down—the  usual  university  stuff—and  then  in 
the  very  last  paragraph  he  says,  "However,  this  is  such  an 
important  experiment  that  you  are  hereby  authorized  the 
nineteen  new  positions  for  graduate  students." 

This  caused  concern  amongst  the  faculty? 

No,  no.   They  didn't  mind  if  they  got  new  slots  so  long  as  they 
didn't  have  to  set  anyone  else  aside.   They'd  take  a  chance. 


Crawford:   They  just  didn't  want  to  give  up  their  own  places? 


266 


Blum:      Anything.   I  mean,  real  academic  pigs.   I  hate  to  say  it,  but 
I'm  not  impressed  with  academia's  sense  of  social  justice. 

Crawford:   Was  there  a  lot  of  infighting  amongst  them? 

Blum:      Always.   Academia  is  a  world  of  great  claims.   It's  not 
necessarily  a  world  of  great  performance.   My  biggest 
disappointment  in  the  university  was  its  pretentiousness. 

But  I  just  took  the  bull  by  the  horns,  and  what  I  did  was 
business  as  usual,  I  guess.  I  short-circuited  everybody- -went 
to  the  dean,  went  to  the  graduate  division—and  got  the  slots. 

One  of  the  least  sympathetic  program  heads  came  charging  in 
as  soon  as  the  new  slots  were  announced,  demanding  two  or  three 
of  the  slots  or  they  would  raise  a  stink  about  the  program. 

At  that  time,  my  office  was  down  on  the  corner  where  Copy 
Central  is  now.   The  planning  project  was  in  that  building, 
over  a  Bill's  Drugstore.   We  were  upstairs  in  a  real  dump, 
sitting  in  pigeon  droppings;  the  windows  were  open  half  the 
time.   I  said,  "Do  you  see  that  door  right  out  there?   I'm 
asking  you  to  get  out  of  here  and  never  come  back  through  that 
door  again.   I  never  want  to  talk  to  you.   You  think  you're 
going  to  blackmail  me?   Just  start  right  out." 

At  that  point,  I  was  chairman  of  the  department,  and  I 
never  did  talk  to  this  person,  a  caricature  of  an  academic, 
again  for  years.  We  didn't  hear  any  more  about  blackmail. 


Blum:      Going  back  to  minority  students,  the  first  class  we  brought  in 
of  about  twenty  or  so  included  a  black  woman  who  had  very 
mediocre  grades  —  a  C+  average--f rom  some  college  in  the  Valley. 
She  got  through  with  us,  got  her  masters  degree,  went  on  and 
got  a  Ph.D.  in  political  science  at  UCB.   That's  a  student  who 
didn't  have  a  B  average.   Political  science  has  got  to  be  one 
of  the  weightiest  departments  on  this  campus.   She  was  a 
wonderful  woman,  and  along  the  way  she  even  did  organizing  in 
Botswana. 

We  had  a  lot  of  interesting  people  who  came  in  under  those 
slots.   We  didn't  count  Asians  or  Jews  as  minorities;  they're 
not  a  minority  in  this  field.   We  would  be  inclined  to  take  in 
an  Italian  because  they're  so  rare—not  anymore,  hopefully,  but 
they  were. 


267 


So  we  took  in  these  people  on  our  special  slots,  mostly 
blacks  and  Hispanics,  as  it  turned  out.   Through  our  planning 
grant  we  had  recruited  many  of  these  people  in  the  summer 
before  to  come  and  look  at  the  university  and  see  what  there 
was ,  and  many  of  them  came  back  in  planning  or  in  health 
education.   They  usually  had  weak  backgrounds  in  science,  so 
that  math  and  statistics  and  epidemiology  would  not  be  their 
first  home.  They  would  be  going  into  something  like  health 
education  or  administration,  which  made  sense,  and  had 
infinitely  more  social  emphasis  and  relevancy  for  them. 

That  girl  I  mentioned  had  organized  a  clinic  for  a  black 
community  when  she  was  in  high  school.   So  who  needs  B's--we 
can't  get  people  with  A's  to  do  that  for  a  black  community.   We 
did  take  in  a  few  minorities  with  high  averages  who  weren't 
worth  a  damn,  just  like  whites  who  had  never  done  anything. 
Book  learning  isn't  where  it  is  —  it's  part  of  it,  but  it's  not 
everything  in  this  field. 

So,  it  was  very  much  fun,  and  the  Indian  recruitment  went 
on  and  on,  and  the  minority  recruitment  went  on  for  a  long 
time,  and  is  supposedly  still  going  on.   We  set  up  a  faculty 
committee,  yet  very  few  of  them  would  even  come  to  the 
committee  meetings.   I  can  name  two  or  three  that  did.   The 
rest  of  the  faculty  wouldn't  even  give  the  time  of  day  to  such 
efforts,  which  of  course  gave  them  very  little  tangible 
rewards.   They  were  getting  ahead;  no  time  to  waste.   They're 
getting  themselves  ahead,  to  be  specific. 


Pressure  to  Publish.  Public  Administration,  and  Alex  Meiklejohn 


Crawford: 


Blum: 


Crawford; 
Blum: 


How  would  somebody  like  that  unsympathetic  program  head  be 
tenured  in  a  department  like  this  one? 

Write  a  book  every  year,  write  a  paper  every  week,  and  usually 
get  somebody  else  to  do  it,  or  it's  a  compendium  of  opinions. 
I'm  not  impressed  with  such  garbage.   It's  easy  work  and 
doesn't  take  any  brains  to  do  it,  but  you  publish,  and  it  gets 
you  in  all  the  best  places. 

You  said  you  didn't  feel  the  pressure  to  publish. 

I  didn't,  because  I  came  here  at  the  top  of  the  ladder  and  was 
soon  tenured.   I  wasn't  the  first  year,  but  I  was  tenured 
shortly  thereafter.   I'd  already  done  my  vision  study—the 


268 


Orinda  Vision  Study—that  was  a  classic  operation.   Then  the 
book  on  administration  was  pretty  fancy  stuff.   It  would  be 
fancier  today,  sad  to  say.   Blum  and  Leonard,  1963,  as  I 
mentioned.   That  was  Public  Administration;  A  Public  Health 
Viewpoint. 

It  was  dedicated  to  Alex  Meiklejohn  because  I  had  really 
understood  through  him,  finally,  what  public  administration  was 
about.   It  has  something  to  do  with  the  country's  philosophy, 
its  people,  and  its  history.   I  never  understood  that  when  I 
went  to  Harvard  and  supposedly  learned  administration.   I 
thought  it  was  something  like  physics  or  math,  something  very 
tangible,  teachable,  and  comprehensible.   But  administration  is 
purely  an  artifact  of  a  culture,  and  I  commenced  to  realize  why 
administration  changed  every  five  or  ten  years—because  the 
culture  was  changing.   Everybody  was  catching  on  a  piece  at  a 
time.   So  the  book  was  devoted  to  that. 

Alex  Meiklejohn  lived  here  in  Berkeley,  and  one  day  Al  and 
I  invited  him  and  his  wife  to  our  house.   We  lived  in  Walnut 
Creek.   And  Alex,  his  wife,  the  Leonards,  and  we  had  lunch. 
Marian,  my  wife,  made  a  very  lovely  luncheon,  and  it  was  a 
beautiful  day,  and  kind  of  open  to  the  backyard.   We  had  a  nice 
place  out  there. 

At  the  end  of  the  lunch,  we  said  to  Meiklejohn,  who  was 
approaching  ninety,  "We  have  a  surprise.   Here's  a  copy  of  a 
book  for  you  that  was  dedicated  to  you."  His  wife  and  he  were 
sitting  side  by  side  on  the  sofa  after  lunch,  and  he  said,  "My 
dear,  isn't  that  exciting."  He  was  very  soft  spoken,  and  spoke 
very  little.   He  was  a  famous  man,  and  revered  in  educational 
circles--at  Amherst--the  leader  who  started  that  whole  new 
movement  in  college  education.   He  looked  at  his  dedication;  it 
was  short  and  sweet,  and  then  he  suddenly  looked  at  his  wife 
with  consternation,  and  said,  "Oh,  my  dear,  do  you  remember 
there  was  another  book  that  was  dedicated  to  me.   It  was  so 
terrible."   [laughs]   That  was  Alex  Meiklejohn.   He  wasn't 
going  to  disguise  his  sudden  remembrance  of  comparable  things 
gone  wrong  in  the  past. 

One  day  his  wife  invited  us  to  a  Bay  Area  Planned 
Parenthood  annual  meeting  where  Gertrude  Jones,  a  world- 
renowned  Planned  Parenthood  gynecologist  from  the  Midwest,  was 
going  to  give  the  lecture.  We  all  went  to  Meikle John's  house 
for  dinner.   It  was  Jones  and  her  husband,  and  Dr.  and  Mrs. 
Meiklejohn,  and  my  wife  and  I,  sitting  together  in  their  house 
right  up  here  on  La  Loma  in  a  nice,  big  comfortable  dining 
room.   Jones's  husband  was  a  corn  farmer  from  Iowa--do  you 
remember  Khrushchev  visiting  a  corn  farm  in  Iowa?  He  was  the 


269 


Crawford: 
Blum: 


brother  of  that  corn  fanner;  a  husky  guy  with  a  big,  open  face 
--kind  of  a  match  for  Khrushchev,  I'm  sure. 

We're  eating  dinner,  and  we're  getting  ready  to  go  to  this 
meeting,  and  he  says  to  Meiklejohn,  "Alex,  how  do  you  feel 
about  all  this  family  planning?"  Alex,  his  eyes  twinkling  as 
usual,  said,  "Well,  I'll  tell  you—I'm  a  ninth  son." 
[laughter]   Wasn't  that  wonderful?  This  is  a  man  of  few  words 
and  lots  of  thought.   I  thought  that  was  magnificent. 

He  wasn't  a  great  proponent  of  family  planning. 

Well,  he  probably  was,  but  give  or  take  a  few  kids.   [laughs] 


Building  a  Planning  Faculty 


Crawford; 


Blum: 


Good  story, 
this  point. 


Well,  we  should  talk  about  the  planning  faculty  at 


I  had  to  build  up  a  planning  faculty,  I  started  recruiting 
people.   I  recruited  some  very,  very  interesting  people,  and 
some  of  them  were  tenured  appointments;  some  were  not. 

Alan  Blackman  I  found  at  City  and  Regional  Planning,  where 
I  taught  briefly  and  got  to  know  most  of  the  faculty.   He  was  a 
fellow  who'd  gone  through  Reed  College  in  Oregon,  which  has  a 
peculiar  reputation.   It  is  fantastically  full  of  brilliant 
people,  and  by  my  standards,  full  of  impractical  folks  at  the 
same  time.   He  was  one  of  their  grads,  and  he  couldn't  quite 
get  organized  to  get  his  doctorate,  but  he  was  smart,  smart, 
and  he  knew  the  planning  field.   So  I  hired  him  on  the  grant 
for  the  first  year,  and  I'll  never  forget,  he's  setting  up  the 
summer  course,  and  it  looks  to  me  like  all  the  big  shot  guest 
lecturers  are  lecturing  on  Sundays. 

I  said,  "Alan,  I  don't  see  this  business  of  putting  people 
on  Sunday.   That  doesn't  sound  like  good  planning  to  me."  He 
gets  his  calendar  out,  and  we're  looking  and  comparing  the 
dates  on  this  little  chart.   It  turns  out  he'd  gone  to  a  yard 
sale,  and  he'd  bought  this  beautiful  calendar,  but  it  was  last 
year's  calendar.   Somehow  I  always  held  this  against  Reed.   I'd 
had  dealings  with  Reed  students  here  before  in  bacteriology, 
[laughter] 


270 


Crawford; 
Blum: 


We  had  our  problems,  and  I  had  to  fire  him,  but  he  was  a 
bright  man.   I  learned  a  lot  from  him.   Everybody  we  hired  had 
something  to  teach  us. 

I  brought  in  Cy  Roseman,  who  eventually  left  his  tenured 
position  here—got  sick  of  it.   He  was  a  tenured  prof  in  health 
planning  and  administration.   And  Dick  Bailey,  who  retired  just 
a  year  or  so  ago,  was  an  economist  and  very  useful  to  us.   He 
did  a  couple  of  beautiful  books  based  on  some  research  that 
almost  fouled  his  own  nest. 

He  was  applying  for  tenure,  and  he  did  a  book  on  economies 
of  scale  in  health  care  in  which  he  interviewed,  visited,  and 
studied  the  records  of  a  great  number  of  physicians  to  see  how 
much  work  they  really  did,  how  many  patients  they  saw,  and 
where  the  time  and  effort  went;  he  discovered  that  groups  of 
three  or  four  doctors  were  the  most  efficient.   Everybody  knew 
that  was  wrong,  so  when  he  came  up  for  tenure,  folks  in  the 
economics  department  said,  "This  is  primary  data.   Who  can  be 
so  stupid  as  to  waste  time  getting  primary  data?"  Meaning,  you 
went  to  the  source  of  where  it  really  is,  not  statistical 
sources  or  secondary  data  which  always  prove  that  it's  more 
economical  to  have  large  groups. 

Well,  large  groups  are  economical  in  one  sense,  they  make 
more  money  per  doctor,  but  that  is  because  they  have  drugstores 
sell  drugs,  all  sorts  of  goodies,  and  that's  where  they  really 
make  their  killing;  but  they  do  less  work  as  doctors.   They  are 
not  more  but  less  efficient  at  doctoring  in  larger  groups. 

In  delivery  of  care? 

In  delivery  of  care.   So  we  had  quite  a  knock-down,  drag-out, 
and  I  really  pulled  out  all  the  stops  as  chairman  of  the 
Department  of  Social  and  Administrative  Health  Sciences,  one  of 
the  two  departments  that  made  up  the  School  of  Public  Health 
after  the  smaller  programs  had  been  merged,  to  have  him 
redeemed  for  getting  primary  data,  when  any  jackass  can  go  get 
secondary  data,  which,  of  course,  in  this  case  isn't  measuring 
effectively  at  all.   It  doesn't  tell  you  what  you  want  to  know. 
So  we  won  that  battle,  and  he  got  his  tenure. 


Crawford:   You  were  chairman  of  the  Department  of  Social  and 

Administrative  Health  Sciences,  known  as  Department  A. 

Blum:      Yes.   Under  Bill  Reeves  the  faculty  divided  the  school  into 
two.   Parts  of  each  department,  however,  couldn't  stand  one 


271 


another,  so  it  could  have  been  better,  but  I  think  that  the  new 
dean,  Pat  Buffler,  has  done  better  by  it  recently. 

But  public  health  is  always  going  to  be  uncomfortable  to 
subdivide.   It's  just  like  a  hospital.   You've  got  a  nursing 
division  that  does  work  all  through  all  areas,  but  then  you've 
got  housekeeping,  that  does  similarly,  and  you've  got  pharmacy, 
and  then  x-ray,  run  by  doctors,  other  services  that  serve  all 
the  departments,  as  personnel,  or  [production?]  and  so  on. 

Crawford:   Not  tidy. 

Blum:      It's  a  three-way  matrix.   I  mean,  this  way  and  this  way  and 

that  way.   You're  constantly  stirring  around.   The  only  person 
I  ever  knew  who  worked  that  out  very  well  was  a  man  by  the  name 
of  Bob  Biller,  who  went  on  to  be  provost  at  USC.   He  was  in 
political  science  and  was  the  first  head  of  Health  and  Medical 
Sciences  here,  and  he  had  worked  this  out  —  this  matrix—the 
difference  in  why  you  go  one  way  one  time  and  another  way 
another  time;  he  put  some  sense  into  it.   But  there  are  always 
problems  with  organizing  public  health  because  there  are  too 
many  disciplines  and  too  many  subjects  and  too  many  kinds  of 
students. 

Crawford:   What  has  Dean  Buffler  done? 

Blum:      She  reorganized  the  school  in  a  new  way,  in  that  faculty  have 
to  establish  a  home  in  one  or  another  of  five  divisions, 
irrespective  of  what  their  own  background  is.   These  divisions 
are  more  nearly  related  to  traditional  subjects  like 
environment,  administrative  sciences,  epidemiology.   But  if  you 
want  to  do  something  with  AIDS,  that  wouldn't  necessarily  be 
just  in  epidemiology  or  contagious  diseases--it  could  and 
should  include  folks  from  sociology  or  maternal  and  child 
health,  it  is  a  cross-cutting  area  of  interest.   Thus  the 
traditional  areas  are  joined  together  by  these  various  problem 
areas—back  to  Leonard  Duhl's  old  theory  that  if  you  had  a 
significant  problem,  no  one  discipline  was  going  to  be  able  to 
take  care  of  it.   This  actually  sets  the  stage  for  urging 
people  from  different  disciplines  to  get  together  and  work 
together.   The  work  that  you  do  commences  to  relate  you  across 
the  board,  not  just  in  the  School  of  Public  Health,  but  to 
other  colleges  and  other  schools.   These  cross-cutting  entities 
may  come  and  go  as  special  problems  or  issues  come  into  being 
or  retreat. 

Crawford:   So  it  encourages  a  kind  of  fluidity? 


272 


Blum:      Yes,  without  disrupting  the  basic  departments,  which  are  then 
crosscut  by  people  doing  different  things. 


Serving  on  Committees  of  the  Academic  Senate 


Crawford: 
Blum: 


Crawford: 
Blum: 


Crawford: 


Blum: 


Was  the  faculty  loaded  down  with  administrative  chores? 

Yes,  to  quite  an  extent.   This  university  had  undertaken  to 
have  a  weak  formal  administration,  and  the  faculty  had  to  do 
the  thinking  and  much  of  the  administering,  which  is  the 
trademark  of  this  university. 

Is  this  different  from  Stanford? 

To  a  certain  extent,  yes.   There's  much  more  faculty 
involvement  in  running  the  UC  system.   The  first  great  revolt, 
in  fact,  was  here  in  Berkeley  in  the  twenties,  and  it  was  about 
having  the  faculty  run  the  university.   When  you  do  that, 
you've  got  to  undertake  to  do  a  lot  of  things,  and  the  Academic 
Senate  is  a  monstrous  bit  of  machinery. 

When  I  first  came  here,  I  thought  I'd  better  learn 
something  about  teaching.   Having  only  taught  off  and  on  for  a 
decade  or  two  elsewhere,  I  found  I  knew  nothing  about  teaching. 
So  I  joined  two  committees  of  the  Academic  Senate;  the  two  most 
preposterous  committees,  I  think,  that  ever  existed.   They're 
still  here,  still  doing  their  good  work—the  course  committee 
and  the  teaching  committee. 

Everybody  on  the  teaching  committee,  obviously,  was  headed 
for  winning  a  teaching  prize.   The  only  thing  they  did  was  give 
out  teaching  prizes.   That  bugged  me  right  off,  because  you 
know  that  teaching  is  often  a  gift.   It  comes  with  certain 
personalities . 


Did  it  come  easily  to  you? 
teacher. 


I  know  you're  a  very  popular 


Oh,  yes.   But  at  the  first  meeting  of  the  Academic  Senate  that 
I  attended,  they  announced  they're  reestablishing  the  teaching 
committee,  and  they  would  give  five  prizes  every  year  to  the 
best  teachers. 

They  also  told  us  that  the  last  time  this  committee  did  its 
work,  three  years  before,  and  nominated  five  people,  every  one 
of  those  five  people  were  fired  that  year,  and  that  that  was 


273 


very,  very  unflattering  to  the  university.   So  they  wanted  to 
have  the  committee  pick  people  who  wouldn't  be  fired.   In  other 
words,  the  fact  that  they  are  superb  teachers  isn't  worth  very 
much  around  here.   This  is  the  first  lesson  I  learned  after  I 
arrived. 

Crawford:   How  do  you  measure  a  teacher's  qualities? 

Blum:      How  do  you  measure?   By  a  mixture  of  popularity  —  students 

saying  this  is  a  fantastic  course,  the  best  course  I  ever  had  — 
and  opinions  of  other  faculty,  too.   So  we  picked  out  five 
people,  and  cleared  each  of  them  with  their  departments,  that 
they  weren't  to  be  fired- -how  do  you  like  that? 

I  started  objecting  pretty  early.   There  was  one  fine 
person  on  the  committee,  and  that's  Marian  Diamond.   She's  not 
only  a  magnificent  teacher  and  researcher,  she's  a  good  human 
being.   Everybody  else  there,  I'm  sure,  was  bucking  for  a 
prize,  and  they  all  got  it,  as  far  as  I  know,  except  me, 
because  I  quit.   I  couldn't  believe  what  I  was  hearing—this 
garbage  about  picking  professors  to  get  a  prize. 

So  I  went  to  the  library  and  got  some  of  the  classic  books 
on  education,  most  of  which  were  written  at  Harvard,  and 
brought  them  to  the  committee,  and  passed  them  around.   I  asked 
them,  "Shouldn't  we  be  looking  at  something  like  this?   I  mean, 
rewarding  the  teacher  for  being  a  good  teacher  is  rewarding 
natural  talent,  and  everybody  who  isn't  that  good  isn't  going 
to  even  bother  anymore.   That's  the  message  that  you're  sending 
out  —  skip  it.   Why  can't  we  look  at  what  teaching's  all  about 
and  try  to  facilitate  better  educational  processes?" 

When  I  handed  out  these  books,  everybody  put  them  down  like 
they  were  contaminated.   They  were  back  to  me  in  thirty 
seconds.   So  I  got  a  stomach  full  and  walked  away  from  that 
committee  shortly  thereafter.   And  then,  one  or  two  of  the  five 
prize-winner  teachers  that  we  picked  were  fired  anyway. 

Crawford:   What  were  the  firings  for? 

Blum:      They  had  come  to  the  end  of  their  promotion  time  without  a 

suitable  production  of  research  and  publications.   You've  got 
so  many  years  to  make  it.   But  that  was  a  pretentious  teaching 
committee-- just  an  abysmal  fraud,  at  best. 

At  the  same  time,  I  had  a  very  similar  experience  in  the 
Academic  Senate  Course  Committee.   They  asked  me  to  review  some 
courses.   There  was  a  course  about  health  that  was  being  taught 
elsewhere  than  in  the  School  of  Public  Health,  and  it  looked 


274 


pretty  good  to  me,  so  I  reported  back  to  the  next  meeting  that 
I  was  happy  to  approve  this  course.   Then  I  approved  another 
one,  and  somebody  realized  that  I  was  kind  of  simple.   They 
said,  "But  maybe  the  School  of  Public  Health  doesn't  want 
somebody  else  to  teach  these  health  courses."  Then  I  caught 
on—this  was  a  turf  protection  society. 

Crawford:   Against  the  threat  of--? 

Blum:      Of  some  other  department  taking  over,  doing  something  useful  in 
your  field.   So  they  had  to  remind  me,  "Is  it  okay  from  the 
School  of  Public  Health  standpoint?"   I  said,  "It's  a  good 
course."  They  didn't  really  care  if  it  was  a  good  course  or  a 
bad  course.   This  was  a  twenty- five  member  committee  that  had 
to  approve  all  courses  to  be  offered  on  the  campus  at  UC 
Berkeley. 


Blum:      Another  kind  of  academic  committee  work  of  probably  more 

significance  goes  on  at  the  level  of  selecting  faculty  for 
tenure.   I  played  an  interesting  but  shabby  role  on  my  first 
plunge  into  that  activity  shortly  after  I  received  my  own 
tenure.   I  discovered  something  about  why  tenured  faculty  might 
not  always  be  particularly  outstanding  figures. 

I  was  asked  to  represent  the  School  of  Public  Health  on  the 
final  Academic  Senate  review  committee  for  each  of  two  School 
of  Public  Health  faculty  being  considered  for  the  tenured 
associate  professorship.   Quite  by  chance  one  committee  met  in 
the  morning  and  the  second  in  the  afternoon  of  the  same  day.   I 
boned  up  on  each  professor's  background  and  publications  so 
that  I  could  participate  intelligently. 

Unfortunately,  as  we  met  for  the  first  evaluation  in  the 
morning,  there  was  no  announcement  of  who  or  what  nor  was  there 
any  paperwork  to  say  which  faculty  was  being  considered.   The 
chair  began  by  asking  me  to  lead  off,  since  I  was  from  the  same 
school,  to  describe  the  candidate's  capabilities  and  output. 
Being  a  relative  newcomer  to  the  university,  I  didn't  know 
anything  about  the  fields  of  the  other  committee  members  and  so 
remained  clueless  about  which  professor  I  was  to  discuss.   I 
was  too  embarrassed  to  admit  my  predicament  and  set  out  to 
describe  our  committee's  target,  but  which  one  was  it? 

I  decided  to  meld  and  generalize  the  two  totally  disparate 
characters  from  different  fields,  one  in  his  late  thirties,  one 
in  his  late  forties.   I  carried  it  off  quite  successfully  and 
concluded  by  saying  that  this  professor  had  a  vigorous, 


275 


youthful  approach  to  his  work.   A  committee  member  immediately 
wanted  to  know  how  come  I  said  youthful,  this  candidate  wasn't 
young  at  all.   I  promptly  caught  on  and  made  a  quick  recovery 
by  saying  that  he  was  a  new  father  this  very  week,  which  was 
true.   Everyone  laughed  and  we  went  on  from  there  quite 
happily. 

Unfortunately,  based  on  that  experience,  I  have  never  been 
able  to  feel  secure  about  the  quality  of  faculty  consideration 
about  appointments  for  tenure. 

I  saw  an  interesting  kind  of  discrimination  in  committee 
work  too,  based  on  a  "this  is  how  we  do  it"  unconcern.   About 
twenty  years  ago  I  was  on  a  search  committee  for  two  tenured 
faculty  positions  in  the  School  of  Social  Work,  serving  as  the 
outside  member.   There  were  two  male  tenured  and  two  female 
non-tenure-track  professors  from  social  welfare  on  the 
committee  as  the  basic  decision-making  group.   Each  search 
position  had  distinctive  needs  and  finally  we  narrowed  down  the 
field  of  candidates  to  one  woman  and  one  man  for  each  slot.   In 
each  case  the  candidates  were  well  matched  and  either  would 
have  been  a  good  acquisition. 

By  the  last  scheduled  meeting  of  the  committee,  it  was 
clear  that  we  would  get  a  good  person  whichever  way  we  decided 
for  each  position.   It  was  also  clear  to  me  that  the  male  was 
the  only  one  in  each  case  who  would  be  put  forward  to  the 
chancellor. 

As  we  opened  the  last  meeting,  I  couldn't  resist  asking  how 
many  tenured  women  faculty  there  were  in  the  school.   The 
immediate  answer  was,  "None."  With  no  further  discussion,  the 
two  women  were  selected  and  shortly  became  faculty.   Even  with 
capable  non-tenured  faculty  women  on  the  committee,  custom  had 
almost  carried  the  day  in  a  field  more  famed  for  its  women  than 
its  men  leaders  and  practitioners. 


Thoughts  about  Teaching  and  W.C.  Fields 


Blum:      You  asked  me  about  teaching.   Although  I  was  almost  always 

treated  as  an  interesting  speaker  and  teacher,  it  is  not  clear 
that  I  was  really  a  good  teacher,  whatever  that  is.   Certainly, 
recorded  renditions  of  various  of  my  talks  or  lectures  leave  a 
lot  to  be  desired:  repetition,  slang,  bad  grammar,  incomplete 
thoughts  keep  them  from  being  very  impressive,  and  this 
recorded  history  is  no  exception. 


276 


Be  that  as  it  may,  students  do  tell  me  that  they  enjoyed  my 
courses,  at  times  when  there  is  no  reason  for  them  to  say  such 
things  other  than  good  feelings—an  issue  to  which  I  shall 
return. 

The  most  startling  of  such  events  of  praise  occurred  one 
day  when  I  was  just  entering  the  elevator  in  Warren  Hall  for  my 
fifth-floor  perch.   A  young  man  in  his  thirties  happened 
aboard,  and  immediately  said,  "You  were  a  good  teacher;  I 
really  enjoyed  your  courses.   You  always  reminded  me  of 
someone."   I  thanked  him  and  as  he  got  off  at  the  third  floor 
he  turned  back  with  some  enthusiasm  and  blurted  out,  "I  know, 
W.C.  Fields."  And  he  was  gone  down  the  hall.   I  didn't  really 
have  time  to  acknowledge  this  compliment,  later  came  home  and 
told  my  wife,  who  wasn't  sure  about  its  implications  either. 

Neither  of  us  had  ever  seen  a  full-length  W.C.  Fields 
production  and  had  our  doubts,  even  though  the  comparison 
seemed  to  have  been  made  with  the  best  of  intentions. 

Within  the  week  we  discovered  that  four  W.C.  Fields  films 
were  being  presented  at  a  theater  in  Berkeley.   We  attended  and 
were  pretty  overwhelmed,  not  altogether  unfavorably.   I  could 
only  assume  that  the  kind  of  gross  exaggeration  that  I  as  well 
as  W.C.  Fields  commonly  indulged  in  had  its  values,  both  for 
emphasis  and  amusement.   We  never  did  explore  the  negative 
possibilities  of  my  relationship  to  W.C.  Fields.   I  can  say 
that  I  had  my  share  of  spirited  students. 

I  think,  however,  that  the  many  thanks  I  got  from  students 
was  in  good  part  based  on  two  quite  different  factors.   One  was 
my  willingness  and  even  enthusiasm  for  going  out  on  a  limb  on 
issues  of  serious  disagreement.   Whether  they  liked  my  stance 
or  not,  they  knew  where  I  stood. 

Of  more  importance  was  being  available  for  assisting  with 
problems,  whether  on  course  materials,  concepts,  university 
pitfalls  and  rules,  or  on  more  personal  matters,  such  as 
health,  family,  jobs,  whatever.   I  am  sure  that  the  dearth  of 
faculty  who  cared  or  would  give  time  made  someone  who  was 
willing  to  help  seem  quite  different  and  important  as  faculty. 
Not  unlike  doctoring,  teaching  also  involves  caring  about  the 
person  who  presents  himself  or  herself  for  assistance. 


277 


American  Public  Health  Association  Involvements  in  the  1960s 


Crawford:   Before  we  move  on  to  the  seventies,  would  you  talk  about  some 
of  your  extra-curricular  activities  such  as  APHA? 

Blum:      I  was  once  on  the  road  in  the  1960s  to  becoming  an  official  of 
APHA.   When  I  was  a  health  officer,  I  was  on  a  whole  series  of 
committees.   One  of  them  was  chronic  disease,  which  included 
alcoholism,  rehabilitation,  and  a  few  other  things--!  was 
chairman  of  that  for  several  years.   Then  I  found  myself  on  the 
governing  council  of  APHA,  which  makes  the  policies.   It's  a 
big  body  which  meets  once  or  twice  a  year—I've  forgotten 
which. 

I  was  also  on  the  Technical  Development  Board.   These  roles 
aren't  on  my  CV--these  are  things  done  in  passing.   The  TDB  was 
made  up  of  about  eighteen  people—half  came  from  California, 
which  I  found  interesting.   This  was  the  leadership  group  where 
the  guts  of  new  decisions  and  policies  were  made  by  APHA.   We 
would  meet  a  couple  of  times  a  year. 

I  finally  discovered  why  there  were  mostly  Californians 
there—California  was  the  only  place  where  government  would  pay 
expenses  for  health  officers  to  go  to  such  meetings.   [laughs] 
There  was  a  different  tradition  out  here.   As  I  told  you,  I 
could  get  my  health  department  to  pay.   They  would  send  me  to 
New  York,  or  wherever  the  meeting  was,  and  that  was  fine.   And 
APHA  was  simply  too  poor  to  buy  our  tickets  and  cover  our 
expenses,  and  we  as  individuals  in  public  health  weren't  well 
enough  paid  to  travel  to  meetings  on  our  own. 

I'll  never  forget  my  last  meeting  at  the  Technical 
Development  Board,  which  as  I  said  is  on  the  way  to  the  top 
leadership,  potentially,  if  you  stay  with  it.   Well,  I  never 
really  liked  to  be  president  of  anything  in  the  first  place. 
It  always  bothered  me  to  waste  my  time  being  president,  because 
it  involves  a  lot  of  ceremonial  activities  which  I  can't  take, 
or  do  well. 

We  had  this  tremendous  meeting,  chaired  by  the  president  of 
APHA.   The  chief  staff  person  was  there,  and  all  nine 
Californians.   The  president's  a  Calif ornian- -we  could  just  as 
well  have  the  meeting  in  Berkeley,  it  would  have  been  cheaper. 

We  are  debating  two  big  measures  about  which  we're  going  to 
testify  to  Congress.   TDB  is  advising  the  APHA  president  on 
what  to  say. 


278 


The  first  measure  was  about  whether  the  U.S.  Children's 
Bureau  should  be  included  in  the  U.S.  Public  Health  Service 
together  with  the  rest  of  the  public  health  programs.   We 
developed  formidable  logic  about  keeping  it  separate.   It  was 
an  interesting,  effective  bureau,  and  trained  a  lot  of  good 
people  and  did  a  lot  of  good  things.  There  also  were  many 
people  in  the  room  who  had  loyalties  to  the  Children's  Bureau. 

So  this  was  a  partisan  measure.  Many  members  of  the  TDB 
didn't  want  the  Bureau  lost  by  putting  it  in  the  Public  Health 
Service,  feeling  that  it  would  be  diluted  out,  and  MCH  budgets 
might  be  screwed  around  with- -they  wanted  to  leave  it  as  a 
separate  agency  reporting  to  God,  you  see.   So  we  developed  a 
logic  of  separateness,  and  I  went  along  with  it. 

Then  the  next  item  we  had  to  decide  on  was  whether  the 
Environmental  Health  Services  should  stand  alone  or  be  made  a 
part  of  the  USPHS.   This  time,  we  all  agreed  that  they  should 
be  included  in  the  Public  Health  Service.   We  developed  all  the 
exact  opposite  arguments  as  to  why  the  Environmental  Services 
should  be  included--a  counterlogic,  almost  word  for  word,  to 
everything  we  had  said  for  the  Children's  Bureau.   So  in  one 
case  we're  going  to  appeal  to  keep  them  separate,  and  in  the 
other  case,  we're  going  to  fight  to  include  them.   I  couldn't 
believe  my  ears. 

I  said,  "Hey,  fellows.   Supposing  you  talk  to  legislators? 
That's  what  you're  going  to  Washington  to  do.   And  some  of  the 
same  ones  are  sitting  on  both  committees.   You  give  them  all 
the  arguments  for  putting  health  services  together,  on  one 
hand,  and  you  give  them  all  the  arguments  for  keeping  the 
pieces  apart  on  the  other?   If  they've  got  all  their  marbles, 
aren't  they  going  to  get  a  little  restive?"  This  thought 
didn't  bother  anyone. 

And  this  is  the  top  level  of  APHA.   So  I  started  thinking, 
Oh,  the  hell  with  it.   I'm  not  going  to  stay  with  this,  and  I'm 
not  going  to  waste  my  time  fighting  it.   I  know  what's  behind 
it,  and  it's  probably  not  going  to  make  any  dif ference--this  is 
playing  both  sides  of  the  street,  and  principle  be  damned.   Of 
course,  they  lost  on  both  of  them.   [laughter] 

At  the  next  governing  body  meeting,  again  a  similar  display 
of  policy  concerns  and  logics.   It's  full  of  "yes  for  this,  but 
no  for  this."  The  same  grounds  are  being  perverted,  just  using 
reverse  arguments,  in  item  after  item.   This  passes  for  policy 
making  and  governance.   Well,  I'm  not  a  perfectionist,  but  I'm 
too  much  of  a  perfectionist  to  put  up  with  having  irrational 
decision  making  every  inch  of  the  way.   So  I  resigned  from  the 


279 


TDB,  and  I  resigned  from  the  governing  board—and  I  never  said 
a  word  about  making  policy.   I  just  figured  the  hell  with  it. 

Crawford:   They  didn't  want  to  know  why? 

Blum:      Nobody  cared  that  much.   Nobody  was  going  to  miss  me,  really. 

Nobody's  ever  missed,  you  know.   At  that  point,  an  aunt  of  mine 
died,  and  she  was  a  person  I  really  loved  to  visit.   She  lived 
in  New  York;  APHA  was  in  New  York  then.   I  thought,  Ah,  I 
really  have  no  good  reason  for  going  to  New  York  anymore.   So  I 
stopped  going  to  New  York  and  the  APHA,  and  that  was  that. 

II 

Blum:      Getting  back  to  being  president  of  things--!  became  president 
of  the  Health  and  Welfare  Council  of  Contra  Costa  when  I  was 
the  county  health  officer,  even  though  I  objected,  and  I 
objected.   That  was  the  first  time  I'd  ever  been  talked  into 
being  president  of  any  thing- -maybe  once  before,  I  had—the 
president  of  the  American  Medical  Student's  Association  at 
UCSF,  but  there  was  a  purpose  to  that.   Nobody  else  would  take 
it  in  their  right  mind  [laughter],  and  yet  the  job  had  to  be 
filled. 

But  I  said  to  these  people,  "Look,  sooner  or  later  you're 
going  to  come  before  the  board  of  supervisors,  for  whom  I  work, 
and  you're  going  to  have  an  issue,  and  you're  going  to  ask  me 
as  president  to  present  it  to  the  board.   The  board  is  going  to 
say,  'Who  the  hell  are  you  working  for?  Us?  Or  this  other 
outfit?'   And  they're  not  going  to  like  it.   It's  already  a 
gross  conflict  of  interest  on  my  part,  as  far  as  the  board's 
concerned,  when  they  see  me  show  up  to  fight  for  something  that 
they  regard  as  none  of  my  business  as  their  health  officer. 
It's  the  wrong  place  for  me  to  be,  and  even  more  so  if  it  is  a 
concern  of  the  health  department's.   If  I  want  to  make  a  case 
before  the  board  of  supervisors  for  something,  I ' 11  do  so,  but 
as  the  health  officer. 

Well,  I  finally  accepted,  and  very  shortly  thereafter  we 
had  some  big  deal,  and  I  had  to  go  before  the  board- -well,  it 
was  preposterous.   So  we  had  to  send  the  vice  president, 
[laughter] 

So  no  more  do  I  ever  make  that  mistake.   I'm  not  president 
of  anything.   I  may  be  chairman  of  a  committee  or  something.   I 
ran  into  the  same  problem  when  I  was  chairman  of  the  board  at 
Alta  Bates,  and  chairman  of  the  board  at  HEALS  at  the  same 
time  —  and  the  two  came  to  blows.   So  I  resigned  at  Alta  Bates. 


280 


Crawford:   Your  point  being  that  you  really  could  be  more  influential  in  a 
different  position? 

Blum:      Yes.   Being  chairman  sounds  good,  but  I've  learned  my  lessons  a 
few  times,  knowing  full  well  what  was  going  to  happen. 
However,  there  are  times  when  there  are  no  choices.   When  I 
wanted  to  run  a  health  department  I  had  to  be  the  health 
officer,  and  when  we  wanted  to  put  the  Joint  Medical  Program 
medical  school  at  UCB  into  shape,  I  had  to  be  the  chair. 
Consultancies  are  fun,  but  being  the  CEO  is  where  the  action 
is. 


Advising  Governor  Reagan—Greed  is  Great;  1967  ti 


Blum:      I  also  worked  for  Reagan  for  a  very  brief  time.   Newly  elected 
Governor  Reagan  selected  a  diverse  committee  of  about  twenty 
persons,  to  be  chaired  by  his  chief  of  staff,  a  successful 
businessman,  to  tackle  the  problem  of  how  to  reform  government 
agencies  to  get  more  useful  work  out  of  them.   I  was  one  of  two 
UC  Berkeley  professors  selected;  the  other  was  the  eminent 
political  scientist  and  public  policy  expert  Aaron  Wildavsky. 

We  never  saw  the  governor  in  the  two  meetings  I  attended 
before  1  was  dropped,  but  we  got  the  full  Reagan  flavor- -why 
are  government  workers  so  lazy,  incompetent,  interested  only  in 
enlarging  the  scope  of  their  duties,  ensuring  the  security  of 
their  own  future  and  caring  not  a  whit  that  their  efforts  at 
enlarging  the  role  of  government  was  interfering  with  the 
profits  of  the  timberers,  developers,  industrialists,  farmers 
who  might  harm  a  few  workers  by  using  pesticides  and  herbicides 
as  they  harvested  California's  green  gold.   This  was  the  first 
time  I  began  to  understand  Mr.  Reagan's  credo,  that  Greed  is 
Great  and  that  greed  makes  America  great.   All  this  could  not 
be  blamed  on  incipient  Alzheimer's,  for  this  man  had  come  from 
the  far  left  in  college  on  to  the  presidency  of  the  supposedly 
left-leaning  actor's  union.   But  there  he  became  the  stool 
pigeon  for  the  FBI,  putting  the  finger  on  liberal  movie 
industry  people. 

This  was  an  interesting  situation  for  two  Berkeley 
academics  who  were  obviously  also  government  employees, 
probably  of  the  most  unproductive  kind,  and  in  my  case  actively 
concerned  with  planning  for  health,  which  could  only  result  in 
some  kind  of  restraints  on  the  earnings  of  the  health  and  other 
sectors,  not  a  minuscule  part  of  our  thriving  economy  but  one 


281 


of  its  major  growth  areas,  and  would  lead  to  restraints  on 
other  sectors  that  adversely  affected  health. 

I  was  not  at  liberty  to  point  out  that  Mr.  Reagan's 
diagnosis  of  the  faults  he  found  in  the  public  sector  were 
exactly  what  one  would  expect  from  greedy  Americans  who  would 
end  up  in  secure  positions  and  make  their  greedy  mark  by  making 
themselves  more  important  and  by  creating  an  even  bigger 
machine  of  government  control,  and  with  more  influence  for  the 
great  profit-makers. 

Since  my  experience  with  government  workers  in  the  health 
and  education  sectors  had  introduced  me  to  thousands  of  persons 
who  in  fact  were  satisfied  with  poor  pay  and  rather  looked 
forward  to  improving  the  safety,  education,  and  health  of  the 
people  of  our  country,  I  felt  that  Mr.  Reagan  was  becoming  a 
pretty  atavistic  character  and  would  soon  be  a  destructive 
force  against  health,  education,  and  conservation  wherever  he 
could. 

In  fact,  the  kinds  of  people  Mr.  Reagan  brought  into  the 
state  government  as  he  set  up  new  and  more  powerful  entities  to 
interfere  with  the  operating  departments  greatly  increased  the 
size  and  cost  of  state  government  while  its  effectivity  was 
lessened  by  slash-and-burn  personnel  policies,  cutting  up  and 
moving  parts  of  departments  like  the  state  health  department, 
one  of  the  best  in  the  country,  into  sites  as  far  apart  as 
Sacramento  and  Berkeley,  getting  incompetent  top-line 
bureaucrats  who  would  hold  up  any  kind  of  health- improving 
measures  that  the  governor  couldn't  kill  legislatively.   Yet 
the  times  were  such  that  more  not  less  health  services  and 
education  were  demanded  and  authorized,  and  it  took  even  more 
expansive  bureaucracies  to  hold  up  and  derail  new  programs. 
Mr.  Reagan's  efforts  to  promote  profits  over  everything  else 
were  actually  attended  by  skyrocketing  state  costs,  obviously 
good  practice  for  what  he  did  as  president. 

The  only  advice  I  could  give  was  that  if  Governor  Reagan 
would  treat  government  employees  as  reasonably  as  normal 
people,  he  might  get  them  to  cooperate  in  mitigating  endless 
bureaucracy,  and  perhaps  see  things  in  a  more  variegated  light, 
one  that  encouraged  the  values  of  production  for  profit,  and 
help  the  producers  see  that  they  too  could  gain  from  helping 
with  a  bit  of  their  profits  to  create  a  healthy  and  educated 
society  that  could  work  harder  and  better.   This  went  over  like 
a  lead  balloon- -government  was  the  enemy  and  had  to  be 
destroyed,  and  I  was  never  invited  back. 


282 


Wildavsky  was  strangely  and  atypically  silent.   He  was  a 
brilliant  thinker,  an  enchanting  speaker,  a  Catskillian  summer 
theater  type  of  entertainer.   Once  when  he  was  asked  to  address 
a  national  gathering  on  policy  for  health  care  he  asked  me  for 
a  few  key  references.   I  gave  him  three,  which  made  it  all  too 
clear  that  health  care,  expensive  as  it  is,  is  not  what  keeps 
us  well.   He  turned  a  hundred  pages  into  a  classic  brief  speech 
that  ended  with  the  oft-quoted  comment  to  the  effect  that  his 
mother's  admonishment  to  use  chicken  soup  and  avoid  the  doctors 
was  good  policy. 

Wildavsky  was  opposed  to  any  and  all  planning,  saying  that 
planners  were  too  ignorant  to  understand  what  the  forces  really 
were  that  they  were  trying  to  harness.   Unfortunately,  a 
realistic  appraisal  of  much  of  planning.   Thus,  they  might  do 
more  damage  than  currently  existed  without  planning  and 
therefore  society  was  better  off  to  be  guided  by  greed,  or  the 
market,  as  we  like  to  describe  it.   He  clearly  was  on  Mr. 
Reagan's  side.   I  called  his  school  of  thought  "I'm  all  right, 
Jack,"  since  he  and  people  like  him  weren't  hurting. 

But  it  was  a  bit  discouraging  for  him  to  be  labeled  as  a 
"hog-in-the-trough"  state  employee.   He  didn't  last  on  the 
committee  either,  as  he  tried  to  raise  the  level  of  the 
discourse  of  Mr.  Reagan's  brain-trusters  as  they  led  the 
committee  to  the  great  new  horizons  offered  by  unbridled  greed, 
and  well-bridled  government. 


Planning  for  Health  and  Expanding  Health  Care  Horizons,  Two 
Textbooks:  1974,  1976 

[Interview  6:  April  3,  1997]  ft 


Crawford:   What  about  changes  at  the  university  after  the  1970s? 

Blum:      In  the  late  sixties,  the  campus  was  very  politically  alert,  and 
social  justice  was  very,  very  important,  but  not  in  the  School 
of  Public  Health.   We  still  had  a  lot  of  professionals  coming 
because  it  was  "the"  thing  to  do,  and  if  you  came  to  school  and 
put  in  another  year  and  got  a  masters  degree,  then  you  might 
get  a  salary  increase  somewhere  or  be  eligible  for  a  better 
position.   Really  impressive. 

Then,  all  of  a  sudden,  that  kind  of  person  died  out.   Early 
in  the  seventies,  we  started  seeing  a  very  different  kind  of 
student,  people  who  were  interested  in  social  justice  and  who 


283 


felt  that  health  was  a  good  place  to  work,  and  who  were 
concerned  with  the  terrible  inequalities  in  health,  and 
inequalities  in  all  kinds  of  things  that  seemed  to  determine 
how  healthy  people  would  be. 

Previous  to  that,  I  don't  think  the  faculty  was  really 
challenged  that  much.   They  were  the  authorities,  but  people 
who  came  to  school  in  the  seventies  certainly  didn't  agree  to 
all  of  that—not  by  a  long  shot.   So  it  became  much  more 
interesting,  much  more  exciting.   There  were  all  sorts  of  fun 
people  that  we  had  to  deal  with,  and  I  had  some  wonderful 
experiences  with  students  here. 

Crawford:   Dr.  Winkelstein  was  dean  for  most  of  that  decade? 

Blum:      He  was  dean  most  of  that  time,  and  he  too  was  concerned  with 

such  things  as  social  justice,  and  was  very  open  to  any  kind  of 
reasonable  suggestions.   Really,  the  life  of  a  professor  at 
Berkeley  was  never  hemmed  in.   You  could  do  your  thing,  and 
there  were  two  issues:  one,  could  you  manage  to  get  something 
published  so  that  it  looked  like  you  were  on  the  ball;  and, 
two,  could  you  attract  students? 

Crawford:   Not  unreasonable  demands,  you  felt? 

Blum:      No,  no.   The  publishing  was  relevant,  if  not  carried  to 

extremes --assuming  you  had  ideas,  and  they  were  worth  airing. 
The  ability  to  attract  good  students  was  a  very  positive  kind 
of  thing—not  the  sort  of  thing  that  the  teaching  committee  was 
interested  in,  unfortunately,  as  I  mentioned  before. 

The  other  day  when  I  went  to  a  meeting  in  Sacramento,  I  ran 
into  people  who  had  been  students  of  mine  thirty  years  ago  and 
who  remembered  what  had  happened  and  felt  very  good  about  it. 
It  wasn't,  "Oh,  here's  this  poor  old  guy,  wandering  around 
Sacramento."  There  was  some  enthusiasm. 

Crawford:   I  have  found  that  to  be  true  in  your  case.   Wouldn't  that  be 
true  of  professors  who  lent  themselves  to  the  students? 

Blum:      Well,  I  think  that  had  a  lot  to  do  with  it.   Yes,  were  you 
there  to  be  sure  that  the  students'  interests  were  covered? 
That  might  mean  covering  your  own,  and,  presumably,  there  was  a 
convergence  of  interest.   They  wanted  what  you  had  to  offer, 
and  you  wanted  to  do  what  they  were  interested  in,  but  it  was 
no  struggle  on  the  part  of  either  party.   So  it  was  a  good 
time,  and  the  students  improved  tremendously.   You  could  hardly 
complain. 


284 


I  think  that  what's  worth  commenting  on,  though,  about 
those  first  few  years  is  that  as  I  look  back  on  it—and  I'm 
really  kind  of  startled—is  my  putting  together  that  first 
textbook  in  1974  on  the  subject  of  planning  for  health  on  a  new 
basis,  Planning  for  Health.   It  wasn't  planning  for  care;  it 
was  planning  for  health.   Much  of  what  I  had  to  say  there 
couldn't  have  been  new.   I  have  long  since  learned  that  other 
people  have  said  these  things  going  back  for  a  couple  thousand 
years,  but  the  basis  of  what  I  had  to  say,  really,  is  just  now 
coming  out  at  WHO,  thirty  years  later. 

There  is  a  WHO  document  that  just  came  over  my  desk  last 
week;  it's  about  a  meeting  held  at  the  end  of  1995.   It  takes 
them  roughly  a  year,  typically,  to  develop  a  document  and 
distribute  it  worldwide—this  went  worldwide.   Almost  all  the 
things  I  was  concerned  with  and  pushed  for  are  finally  here.   I 


Thirty  years 


feel  very  good  about  their  getting  on  the  ball, 
later?  That's  not  bad. 

Crawford:   What  has  been  the  usage  of  your  planning  book? 

Blum:      Very,  very  limited—two  editions.   It  crops  up  in  odd  places. 
A  fellow  came  by  here  the  other  day  who  had  never  gone  to 
school  here,  but  who  works  in  Washington,  D.C.,  and  he  had  a 
book  in  tow.   He  said,  "Look  what  I  found  in  the  second-hand 
bookstore.   I  want  you  to  autograph  it."   [laughs]   It  was  a 
first  edition  of  Planning  for  Health. 

Crawford:   How  many  editions? 

Blum:      Just  two.   [Second  edition:  Human  Sciences  Press,  New  York, 
1980.] 

Crawford:   Is  it  still  used  as  a  textbook? 

Blum:      I  seriously  doubt  it.   It  wasn't  heartily  received  then, 

because  it  ended  up  saying  you  just  simply  can't  look  at  health 
care  as  any  answer  to  improving  health.   Health  care  is  where 
all  the  money  goes,  but  it  doesn't  improve  health  in  people 
very  much.   The  real  issues  are  social  and  economic,  and 
cultural  and  educational;  I  called  all  that  environmental. 

I  remember  my  big  battle  with  the  U.S.  Public  Health 
Service.   To  this  day,  they  claim  that  environment  is  18 
percent  of  the  problem,  and  behavior  is  50  or  60  percent. 
Someone  named  McGinnis  put  all  that  together  and  gave  a  lecture 
here.   My  students  really  took  him  apart.   "How  can  you  say 
such  nonsense?  The  environment  is  what  determines  how  healthy 
you're  going  to  be."  He  said  that  by  the  environment  he  only 


285 


Crawford: 
Blum: 

Crawford: 
Blum: 


meant  the  air  and  the  water  and  the  soil  and  the  accidents  on 
the  job  kind  of  stuff.   Social  and  economic  and  educational  and 
cultural  issues  were  not  assigned  to  the  PHS  and  thus  not  in 
their  definition  of  environment,  and  so  he  could  freely  say 
that  environment  was  not  a  big  factor.   This  was  and  continues 
to  be  the  position  of  the  USPHS,  where  he  is  an  assistant 
surgeon  general. 

So  if  you  looked  at  it  that  way,  and  got  rid  of  all  the 
major  causes  of  good  or  bad  health,  then  you  could  say  that 
behavior  was  the  remaining,  single,  largest  factor.   These 
would  be  purely  behavior;  smoking  and  drinking,  dangerous 
driving,  and  sex.   All  of  this  you  could  bounce  back  on  the 
individual,  and  most  importantly,  avoid  asking  for  social 
change . 

The  other  bit  of  stupidity  in  taking  that  position  is  that 
there  is  no  such  thing  as  behavior  without  an  environment.   The 
environment  dictates  or  creates  behavior.   How  is  it  that  all 
the  smoking,  practically  speaking,  occurs  in  certain  places  and 
certain  groups?  How  come  all  the  heavy  drinking  likewise?  And 
how  come  all  the  promiscuity?  These  are  real  problems,  they 
occur  in  certain  socio-economic,  cultural  environments,  and 
those  are  not  just  god-given  behavioral  factors.   They  are 
responses  of  human  beings  who  seem  to  experience  these 
differences  in  environment.   But  changing  behavior  is  the 
garbage  that  is  officially  peddled  in  the  United  States.   Yes, 
it  can  and  does  work  in  some  situations,  but  usually  not  among 
the  people  who  need  to  change  the  most. 

We're  not  further  along  the  road? 

Not  in  the  United  States,  but  very  much  in  most  other 
industrialized  countries. 


Were  you  instrumental  in  this  new  work,  do  you  think? 
certainly  that  was  the  thrust  of  your  report. 


Because 


It  is  hard  to  know.   I  suppose  so.   A  lot  of  people  picked  it 
up.   At  the  identical  time  that  I  was  doing  this  work  in  the 
1970s,  the  Canadians  did  the  same  thing—except  it  was 
published  by  the  Canadian  government.   It  was  called  The  La 
Londe  Report.   I  was  working  for  PAHO  occasionally  at  that 
time,  and  in  the  PAHO  office  I  met  the  man  who  wrote  that 
report  for  La  Londe.   His  name  was  La  Framboise.   He  had  all 
these  wonderful  charts  and  pictures,  and  they  were  the  same 
sort  of  things  that  I  had. 


286 


Neither  of  us  had  ever  heard  of  one  another,  and  we're 
sitting  there  in  New  York  looking  at  one  another,  and  it's  just 
astounding.   They  published  hundreds  of  thousands  of  copies  and 
distributed  them  around  the  world;  the  La  Londe  Report  had  a 
serious  influence,  yet  was  never  taken  seriously  in  the  U.S. 
because  it  smacked  of  social  justice. 

La  Londe  was  a  gifted  and  trusted  man  who  was  the  head  of 
health  and  welfare  for  the  Canadian  government,  under  Trudeau. 
And  then,  when  he  got  through  giving  real  credibility  to  the 
health  sector,  La  Londe  was  shifted  over  to  law,  where  he  also 
did  very  fine  work.   He  was,  apparently,  a  powerful  force.   The 
interesting  thing  is  that  almost  all  of  the  new  Canadian  era  of 
understanding  the  origins  of  health  were  inspired  in  French 
Canada. 

All  of  this  was  based  on  the  work  of  another  committee 
headed  by  Castonguay  and  Nepveu.   They  took  about  five  years  to 
develop  the  theory  of  health.   They  covered  the  philosophy  of 
every  civilization,  practically—and  they  came  up  with  the 
notion  that  health  was  really  based  on  response  to  environment. 

Crawford:   Does  this  thinking  come  from  France  originally? 

Blum:      Not  from  France,  but  from  French  Canadians.   And  yet  it  was 
once  in  France,  too,  a  long,  long  way  back—but  with  no 
continuity. 

The  commission  lasted  for  about  five  or  six  years,  and 
Castonguay,  of  all  things,  was  an  insurance  man,  brought  from 
the  private  sector,  where  he  was  one  of  these  people  who 
measures  risk—in  any  event,  brilliant.   The  commission  issued 
a  seven-volume  study,  which  I  once  bought  and  finally  gave  to 
the  library.   I'm  sure  it's  been  lost  since,  but  the  Castonguay 
and  Nepveu  Report,  which  resulted  in  the  La  Londe  kind  of 
thinking,  was  very  much  a  product  of  these  French-Canadians. 

Crawford:   What  have  your  Canadian  students  found  their  way  into? 

Blum:      Well,  they're  almost  all  in  health  work  of  one  sort  or  another. 
The  Canadian  government,  particularly  in  several  of  the 
provinces,  did  lots  of  wonderful  things  that  I  also  thought 
needed  to  be  done.   They  put  together  health,  welfare,  and 
mental  health,  and  said,  "This  is  people,  this  is  human 
service.   It  belongs  together."  They  did  that  in  many 
provinces  —  and  did  a  good  job.   They're  way,  way,  way  ahead  of 
us . 


287 


Crawford: 


Blum: 


Crawford; 


Blum: 


Crawford: 
Blum: 


We  always  hear  people  saying  they  will  go  to  Canada  when  they 
retire  to  get  good  health  care. 

Well,  of  course,  that's  real  care--not  just  medical  care.   When 
you  say  health  care  here,  it  always  means  medical  care;  not 
there. 


You  worked  on  curriculum  development, 
into  the  seventies  and  eighties? 


How  did  that  develop 


We  became  aware  of  the  fact  that  what  most  people  call  policy 
was  just  one  more  manifestation  of  planning.   Or,  at  least  —  for 
a  planner,  you  could  plan  in  many  places  and  at  many  levels, 
and  the  first  area  you  would  probably  want  to  plan  for  would  be 
policy—what  is  it  we  want,  and  after  that  how  are  we  going  to 
get  it? 

But  then  as  you  plan  for  this  and  you  plan  for  that,  you 
finally  come  down  to  planning  for  services  at  the  end  of  the 
line,  it's  just  a  continuum.   If  you  don't  have  any  policy,  I 
challenge  you  to  come  up  de  novo  with  services  that  are 
meaningful,  because  you  don't  know  with  what  purposes  you  are 
carrying  them  out. 

You're  not  going  to  do  the  policy  work  successfully  unless 
you  have  some  sense  of  what's  involved  in  this  field.   So  in 
health,  I  had  to  start  with  health.   I  didn't  see  how  you  could 
plan  for  health  if  you  didn't  know  what  health  was  or  what 
affected  it.   That  was  the  first  statement  1  made  to  myself. 

Your  focus  was  really  policy? 

Well,  it  was  a  mixture.   I  ended  up  calling  myself  a  professor 
of  health  policy  and  planning,  because  we  got  into  policy  in 
fairly  short  order,  thanks  to  some  wonderful  students.   I  told 
you  about  how  the  planning  course  started,  with  each  student 
doing  a  piece.   But  the  policy  course  per  se  involved  a  pre-med 
student  who  got  an  M.P.H.  here  and  who  is  now  at  the  National 
Institutes  of  Health,  Pamela  Gurnick.   She  just  sat  down  with 
me  for  the  best  part  of  a  semester,  and  we  hatched  out  the 
policy  planning  course,  but  it  was  much  her  doing—a  terribly 
bright  person. 

We  grew  into  policy,  because  it  became  clear  you  couldn't 
not  grow  into  policy- -you  had  to  do  it  if  anything  was  to  take 
place. 


288 


Crawford: 


Blum: 


In  1976,  you  published  Expanding  Health  Care  Horizons. 
Party  Associates,  Oakland] 


[Third 


That  book  originated  as  an  invitation  to  present  up-to-date 
thinking  on  what  health  was  and  what  health  care  might  best  be. 
Each  of  three  authors  was  given  a  week  in  which  to  present 
their  views.   Ivan  Illich  presented  Medical  Nemesis,  Rick 
Carlson  did  the  End  of  Medicine,  and  I  presented  what  health 
care  should  be  doing  if  it  were  based  on  our  understanding  of 
what  caused  good  and  bad  health,  something  a  lot  different  than 
the  repair  concept  of  Western  medicine. 

Roz  Lindheim,  an  architect  whose  work  in  health  opened  many 
new  avenues  in  health  care,  appears  in  several  contexts  in  this 
book  because  she  influenced  many  of  us  in  many  ways,  got  me 
invited  to  Cuernavaca  to  CIDOC,  Centre  Intercultural  de 
Documentation,  which  was  Ivan  Illich1 s  own  institute  and  which 
enjoyed  the  protection  of  the  liberal  archbishop  of  Cuernevaca. 
Illich  was  a  priest  who  came  from  Yugoslavia,  was  trained  at 
the  Vatican  and  was  reputed  to  be  a  protege  of  Pope  John. 

He  had  written  many  controversial  books,  all  of  which 
sounded  a  strong  anti-organization  theme,  probably  built  out  of 
his  experience  and  objections  to  bureaucratic,  authoritarian 
organizations  like  the  Catholic  Church.   As  the  one-time  rector 
of  the  Catholic  University  of  Puerto  Rico,  he  had  strong 
feelings  about  the  limitations  of  traditional  universities  and 
CIDOC  was  his  own  creation. 

The  institute  earned  its  way  by  teaching  Spanish  to  well- 
off  persons  needing  a  rapid  and  reasonably  thorough  Spanish 
grounding.   But  its  overriding  purpose  was  to  piggy-back  high- 
level  discussions  of  all  major  social  issues,  as  well  as 
maintain  an  elegant  library  and  a  place  for  him  to  think  and 
work.   His  medieval-style  university  CIDOC  was  an  unlikely 
mixture  of  the  ultra-technical  reception  machinery,  and  a 
freedom  to  wander,  imbibe,  and  disperse  information  and  ideas 
in  an  almost  market-like  intellectual  setting. 

When  one  arrived,  one  was  set  down  in  front  of  a  suitcase- 
sized  mechanized  monster  which  took  your  fifty  dollars,  took 
your  picture  and  a  small  ticket  you  had  filled  out,  and  turned 
out  a  wallet-sized  plastic-encased  I.D.  card  that  allowed  you 
to  attend  for  the  rest  of  the  year.   That  allowed  the  card 
holder  to  attend  any  and  all  presentations,  of  which  there  were 
a  dozen  or  more  going  on  at  any  one  moment. 


289 


It  might  be  medicine  one  month,  a  four-hour-a-day  series, 
with  half  presentation,  half  discussion,  history  of  the 
Philippines  which  we  attended,  or  philosophy,  whatever. 

Illich  toured  each  series  at  least  once  a  week  and  gave  a 
resume  of  all  the  courses  that  were  being  presented,  truly  an 
unbelievable  tour  de  force.   We  had  attendees  in  ours  from 
twenty-three  countries,  and  since  presenters  were  paid 
according  to  the  number  of  attendees  (out  of  their  $50.00 
fees),  we  were  paid  more  money  than  it  cost  us  to  travel  and  to 
stay  there  for  a  week. 

To  prepare  myself,  I  put  all  my  ideas  into  paradigms, 
chains  of  logic,  summaries,  and  presented  about  a  hundred 
charts  and  tables  in  my  week.   Given  its  success  with  an 
international  audience,  I  did  what  any  respectable  professor 
would  do:  turned  it  all  into  a  book,  Expanding  Health  Care 
Horizons,  a  title  suggested  by  a  confrere  who  then  denied 
vigorously  that  he  had  ever  named  anything,  even  though  he 
approved  of  the  book.   I  obtained  a  contract  from  Warner,  and 
Harry  Specht,  the  dean  of  the  School  of  Social  Work  at  UC 
Berkeley,  was  the  editor  for  them. 

Harry  had  worked  under  me  as  the  CEO  of  the  Contra  Costa 
Health  and  Welfare  Council  for  the  one  year  I  was  its 
president,  and  we  enjoyed  one  another.   He  went  on  a  sabbatical 
to  Europe,  injured  his  back,  and  lay  on  the  floor  of  their 
leased  van  for  months  while  his  wife  drove,  and  that  was  where 
he  edited  my  book.   He  did  a  magnificent  job  sharpening  and 
clarifying,  never  once  ruining  what  I  was  getting  at. 

After  all  that,  Warner  was  sold,  perhaps  it  became  Time- 
Warner,  it  cancelled  its  contracts,  and  here  1  was.   I  wanted 
the  book  for  my  classes.   Because  it  laid  out  the  new  look  for 
health  care  that  I  wanted  to  use,  a  pair  of  former  students, 
Helen  and  Paul  Mico,  who  created  a  publishing  house  at  that 
moment,  Third  Party  Publishing,  took  it  as  their  first  venture. 
Since  they  had  so  few  books,  they  had  no  budget  for 
advertising,  so  it  remained  mostly  for  local  consumption.   It 
brought  all  my  major  themes  together  and  from  time  to  time  I 
get  asked  to  sit  in  on  the  founding  of  a  health  care  venture 
based  on  the  premises  held  forth  in  that  book. 

We  had  a  lot  of  dealings  with  Illich  while  we  were  there, 
partly  fascinated,  partly  repulsed  by  this  formidably  talented, 
educated,  and  experienced  empiricist.   Fascinated  by  the 
searching  questions  he  asked,  repulsed  by  the  elitist  answers 
he  typically  gave. 


290 


Wasn't  organized  education  creating  a  great  subclass  of 
those  who  never  could  get  any  of  it,  therefore  shouldn't  we  do 
away  with  organized  schooling?   Similarly  for  medicine,  and  so 
on.   My  preface  to  Expanding  Health  Care  Horizons  responds  to 
that  philosophy  rather  vigorously. 

Anyhow,  we  thought  he  would  be  good  for  Berkeley,  got  him  a 
Chancellor's  professorship,  and  he  spent  a  semester  in 
presenting  a  formal  course  on  gender  [1982-1983]  and  holding 
parallel  seminars  and  soirees  on  various  related  issues.   I  did 
all  the  necessary  paperwork  and  petitioning.   Roz  was  in 
Europe,  and  I  sat  back  to  enjoy  what  could  only  become  an 
intellectual  fracas. 

His  class  drew  500-700  people  for  every  single  lecture. 
The  large  home  he  rented  with  his  stipend  was  busy  at  all  hours 
with  truly  intellectual  forays.   This  was  old-time  intellectual 
fare  of  the  highest  order.   Several  UCB  women  faculty  were 
truly  indignant  over  what  this  maybe  celibate  priest  had  to  say 
about  gender  issues,  and  proceeded  to  write  heated  responses  in 
book  form. 

He  has  been  at  Heidelburg  the  last  few  years  and  is,  by  my 
standards,  becoming  more  respectable  or  less  controversial. 


The  Hospital  World:  Alta  Bates  and  Herrick  Hospitals  and  HEALS 


Blum:      At  the  same  time  during  the  seventies,  I  got  pulled  into  the 
hospital  world,  which  I  also  loved,  even  though  it  was  a  long 
way  from  policy  planning  at  the  community  level.   I  was  asked 
to  help  with  the  planning  at  Alta  Bates  Hospital,  and  that's 
because  of  former  students  who  were  now  running  Alta  Bates. 

Crawford:   Let's  talk  about  that. 

Blum:      In  the  seventies,  I  was  planning  with  Alta  Bates,  and  they  and 
Herrick  were  in  sort  of  a  death-throes  battle  for  survival. 

One  of  my  co-professors,  Dave  Starkweather,  was  the  key 
force  on  the  board  at  Herrick.   He  didn't  want  to  be  the 
chairperson  there,  because  he  was  wise  about  that,  but  he  was 
certainly  the  brain  there.   I  got  to  be  pretty  much  head  of  the 
planning  at  Alta  Bates,  although  they  had  several  full-time 
planners  on  the  staff.   They  were  well-paid  people. 


291 


He  and  I  came  to  a  pretty  rapid  understanding  that  no  way 
could  the  two  hospitals  survive  in  Berkeley.   This  was  in  the 
early  seventies.   It  was  just  ridiculous.   They  were  going  to 
have  to  join  together.   In  1981  I  went  onto  the  board  at  Alta 
Bates,  and  ultimately  became  chairman  of  the  board  for  a  brief 
period- -it  was  my  last  year  there,  at  which  time  the  two 
hospitals  were,  literally,  joined,  and  made  into  one,  which  is 
now  called  Alta  Bates.   We  finally  engineered  it,  and  it  took  a 
long  time,  until  1984.   First,  we  went  through  the  trustees, 
who  were  not  physicians.   The  physicians  hated  one  another. 
The  administrators  hated  one  another. 

Crawford:   Is  that  surprising? 

Blum:      Well,  no,  you  want  the  business,  they  want  the  business,  and 

there's  not  enough  business—that '  s  the  real  issue.   Remember, 
at  this  point,  there  were  new  hospitals  coming  into  service  in 
Alameda  County,  Contra  Costa  County,  and  so  on.   In  the  case  of 
Contra  Costa,  patients  that  used  to  come  to  Berkeley  went  to 
John  Muir,  and  maybe  to  Concord,  to  Mt.  Diablo,  and  maybe  to 
Brookside  in  San  Pablo,  and  then  to  Doctor's  Hospital  in 
Pinole.   At  that  time  Kaiser  was  also  making  huge  inroads  into 
patient  care. 

Crawford:   Is  Kaiser  not  a  good  program? 

Blum:      No,  that's  not  the  issue.   It  was  making  horrible  inroads , 
taking  customers. 

Crawford:   Enormous  inroads,  but  not  negative  ones? 

Blum:       I  don't  think  so.   People  got  at  least  as  much  as  they  had  ever 
gotten—for  a  lot  less. 

Crawford:   Was  this  the  era  of  the  MBAs,  when  they  came  in  to  administer 
in  hospitals? 

Blum:      Yes,  and,  in  fact,  Starkweather  was  specialized  in  hospital 

administration,  and  I  was  not.   I  was  interested  in  health  care 
in  a  broad  sense,  but  I  played  the  narrow  hospital  game,  too. 
That's  how  you  learn  what's  going  on,  if  you're  in  it. 

Under  his  auspices  and  doing  the  work,  but  under  my 
chairmanship,  we  set  up  the  joint  masters  degree  between  the 
School  of  Business  and  the  School  of  Public  Health.   With  a 
three-year  program,  a  student  could  get  two  masters  degrees,  as 
I've  said,  and  they  were  typically  headed  into  the  Kaisers,  the 
Blue  Crosses,  and  the  Blue  Shields  of  the  medical  world.   We 
trained  a  lot  of  students  that  way—we're  still  doing  it. 


292 


Dave  Starkweather  and  I  were  very,  very  different  people, 
and  we  were  interested  in  very  different  things.   He  was  very 
much  a  computer  nut,  and  I  could  care  less--I  haven't  seen  any 
good  thinking  coming  out  of  a  computer.   I  was  interested  in 
which  way  to  go  on  issues,  and  he  was  interested  in  getting 
there.   So  it  was  a  good  match-up.   All  my  students  tended  to 
take  his  courses,  and  his  students  tended  to  take  my  courses, 
but  then  they  pulled  apart  when  it  came  to  a  career.   They  were 
very,  very  different  people,  obviously.   But  it  was  good  for 
the  two  of  us,  each  in  his  own  department  and  each  in  his  own 
hospital,  and  able  to  exchange.   We  had  adjacent  offices,  you 
see,  in  Warren  Hall. 

So  we  got  these  two  hospitals  together.   One  of  the  big 
battles  we  had  lived  through  was  over  emergency  services. 
There  was  a  statewide  program,  which  has  since  somewhat  fallen 
to  pieces,  of  having  emergency  services  —  good  ones.   There  was 
the  issue  of  whether  it  would  it  be  Alta  Bates  or  Herrick  that 
would  be  the  chief  emergency  servicer  in  the  Berkeley  area,  and 
remember,  emergency  generates  business.   People  come  in  who 
have  no  intention  of  coming  in,  but  they're  there,  and  when 
they  need  hospitalization,  you've  got  them.   Often,  it's  around 
accidents,  and  in  those,  there's  usually  money—there' s  some 
insurance  or  something,  you  see.   Many  people  can  pay.   Well- 
to-do  people  also  get  into  accidents. 

Anyhow,  Herrick  was  much  more  dependent  on  its  emergency 
room  than  Alta  Bates.   Alta  Bates  was  slowly  pushing  its  way 
in,  and  they  just  about  displaced  Herrick.   So  here  we  were, 
with  great  big  meetings  going  on  about  how  we  ought  to  work 
together  and  not  kill  one  another,  yet  there  was  only  room  for 
one  such  service  in  the  area.   This  is  what's  known  as 
competition  in  the  hospital  business,  and  it  means  that  prices 
go  up  and  up  and  up  for  everybody,  because  everybody  is  trying 
to  do  everything  without  adequate  volume. 

So  we  had  this  meeting,  and  I  was  still  chairman  of  the 
Alta  Bates  planning  group,  but  not  on  the  board  at  Alta  Bates 
yet;  it  was  early  in  the  eighties.   We  listened  to  all  the 
competing  claims,  and  it  was  crystal  clear  to  me  that  Alta 
Bates  was  chiseling  its  way  into  Herrick1 s  territory.   I  had 
been  appointed  as  one  of  the  people  on  the  committee,  and  there 
was  the  chairman  of  the  Alta  Bates  board  as  chair  of  the 
meeting,  a  man  by  the  name  of  Manlove,  a  very  interesting, 
powerful  force  on  the  Alta  Bates  board. 

I  listened  for  an  hour  or  so,  and  I  said,  "Well,  Mr. 
Chairman,  as  a  member  of  this  committee,  I  move  that  we  agree 
to  give  the  emergency  services  to  Herrick.   That's  where  it 


293 


started,  that's  where  we  all  agreed  it  was  to  go, 
that  we  honor  that  agreement." 


and  I  suggest 


So  it  was  moved,  seconded,  and  passed  with  only  one  or  two 
negative  votes.   It  was  just  so  obvious,  it  had  to  be  that  way. 

When  I  came  home,  it  was  on  a  Friday  evening.   I  said  to  my 
wife,  "We're  going  to  get  a  phone  call  shortly,  and  we're  going 
to  hear  from  the  chairman  of  the  board  of  Alta  Bates,  and  I'm 
going  to  be  disengaged  from  any  further  work  for  Alta  Bates," 
because  I  had  really,  really  kicked  in  that  whole  profitable 
business,  thoroughly  and  intentionally.   I  don't  believe  in 
stealing,  even  between  public  institutions.   [laughter] 

Sure  enough,  we're  sitting  down  to  dinner,  and  the  phone 
rings,  and  she  says,  "A  man  by  the  name  of  Manlove."   I  said, 
"Hi,  Bob,  what  can  I  do  for  you?"  He  said,  "We  need  you  on  the 
board  of  trustees  at  Alta  Bates."   [laughter]   I  said,  "Really, 
I  hadn't  come  to  that  conclusion,  myself."  Then  I  said,  "Sure. 
I'd  love  to."  Given  the  occasion,  it  was  a  good  augury. 

So  that's  how  I  got  on  the  board  at  Alta  Bates.   It  was 
just  the  exact  opposite  reaction  of  what  I  expected. 

Crawford:   They  recognized  a  strong  man. 

Blum:      It  wasn't  just  that.   Their  move  was  foolishness.   How  much 

chiseling  can  you  do,  in  the  long  run,  with  everyone  watching? 

So  I  stayed  on  the  board,  and  we  had  a  wonderful  era  of 
planning.   The  administrator  there,  who  was  very  antagonistic 
to  Herrick  at  the  time,  was  a  very,  very  bright  guy.   He  is  a 
real  big  shot  around  here  now,  and  somebody  that  I  always 
enjoyed  working  with- -Bob  Montgomery.   A  good  planning  group 
was  just  critical  to  everything  he  undertook. 

Just  about  that  time  things  for  Alta  Bates  really  settled 
in  and  became  hard--I  mean,  we  had  gotten  the  Medi-Cal  decision 
that  it  was  only  going  to  pay  so  much.   I'll  never  forget  the 
trouble  we  had  getting  the  board  to  understand  that  if  our 
average  cost  per  day  is  $900,  and  Medi-Cal  only  pays  $600,  that 
we're  really  not  losing  $300  a  day  if  taking  in  that  new 
patient  into  an  otherwise  empty  bed  only  costs  us  $400  a  day  to 
take  care  of.   Never  mind  the  average  cost;  the  truth  of  the 
matter  is  that  if  this  Medi-Cal  patient  costs  us  $400  and 
they're  giving  us  $600,  we  just  got  through  making  $200.   That 
sort  of  thing  was  particularly  enjoyable,  because  I  got  to  know 
a  lot  more  about  what  I  was  teaching,  in  contrast  to  many 
teachers  who  had  little  contact  with  actual  operations. 


294 


Crawford:   The  real  thing. 

Blum:      Yes,  in  contrast  to  most  people  who  teach  and  do  exhaustive 
research  on  some  arcane  issue.   They  read  about  it  in  the 
literature,  and  this  particular  set  of  discoveries  showed  up  at 
least  five  or  six  years  later  in  the  literature.   Well,  here 
you're  living  it  right  now--I'm  representing  a  hospital  and 
going  to  Sacramento,  and  arguing  about  the  rates,  and  trying  to 
get  a  little  more  money  for  Alta  Bates  from  the  state. 

Crawford:   From  Medi-Cal? 

Blum:      Yes,  and  it  was  feasible,  and  we  did  get  some  more.   And,  at 

the  same  time,  hassling  with  Herrick  and  saying,  "Come  on,  come 
on.   If  we  get  together,  we  can  all  survive."   Sure  enough,  the 
docs  were  finally  amalgamated,  and  the  cardiac  group  that  was 
Herrick  and  the  cardiac  group  at  Alta  Bates  have  gotten  along 
famously  ever  since  as  one  group.   They  are  all  part  of  a 
bigger  medical  group. 

Crawford:   Which  is  what? 

Blum:      Well,  it  was  just  a  group  of  heart  people  that  now  relate  to 

Alta  Bates,  but  they  used  to  relate  to  two  hospitals.   Now  it's 
a  big  operation.   They  couldn't  have  survived  divided.   Alta 
Bates  had  trouble,  even  after  they  amalgamated,  to  really  get 
through  some  of  those  bad  years.   The  doctors  and  the  hospitals 
slowly  learned  to  work  together  as  both  were  in  danger 
otherwise . 

As  soon  as  we  amalgamated  the  two  hospitals,  we  turned  to 
Blue  Cross  and  said,  "We  want  more  money  for  hospitalizing  your 
cases . " 


Crawford: 
Blum: 


We  suddenly  had  the  control  of  the  local  market.   There  was 
no  more  Herrick  to  compete  with;  there's  no  immediate 
competition.   We  could  work  more  cheaply  together,  but  at  the 
same  time,  we  didn't  have  competition.   So  we  could  tell  Blue 
Cross,  "We  want  more  money.   Otherwise,  you  have  got  to  make 
your  Berkeley  subscribers  go  to  Pill  Hill"--well,  they  may  not 
want  to  go  to  Pill  Hill. 

What's  Pill  Hill? 

The  amalgam,  there,  of  Merritt  and  Peralta  and  Providence-- 
that's  Pill  Hill.   That's  just  five  or  ten  miles  away,  but 
Berkeley-oriented  people  don't  want  to  do  it.   They'll  buy  some 
other  insurance  if  they  want  to  stay  here.   Most  people  don't 
enjoy  changing  their  source  of  medical  care. 


295 


Crawford:   You  had  a  good  bargaining  wedge. 

Blum:      All  the  stuff  that  isn't  supposed  to  be,  you  learn.   We  had 
meetings  at  seven  in  the  morning  practically  every  day,  and, 
then,  at  noon  many  a  day;  and  then  in  the  evenings—either 
during  dinner  or  after  dinner. 

Crawford:   All  the  while  working  full-time  here. 

Blum:      Yes,  it  was  really  a  wonderful  time,  and,  at  one  point  in  the 
seventies,  Bob  Montgomery  and  I  and  a  few  other  people  had 
decided  we  should  have  our  own  HMO.   If  Kaiser  got  all  the 
business,  they'd  send  their  subscribers  not  to  us  but  to 
Kaiser's  facilities.   So  we  created  HEALS,  an  HMO,  in  1978. 
Before  it  was  all  over,  I  was  chairman  of  that  board  for  some 
years,  from  1984  to  1987.   My  last  year  on  the  hospital  board 
was  the  year  the  merger  really  sank  in,  about  1984.   Chairman 
of  the  Board  of  Trustees-- ' 84.   So  it  was  that  late.   It  took 
all  those  years  and  years  and  years  of  struggling. 

II 

Blum:      But  to  get  to  HEALS:  several  physicians  at  Herrick  wanted  to  do 
something,  felt  we  just  had  to  stop  Kaiser's  inroads,  and  the 
administration  at  Alta  Bates  felt  the  same  way.   This  is 
interesting—it  wasn't  the  docs  at  Alta  Bates,  and  it  wasn't 
the  administration  at  Herrick.   Between  us  we  finally  convinced 
each  of  the  organizations  to  put  up  some  money,  and  we  would 
partner  equally  in  setting  up  HEALS.   The  name  was  suggested  by 
a  doctor  from  Herrick.   It  was  a  good  name.   HE  and  ALS 
represented  key  letters  from  Herrick  and  Alta  Bates. 

Crawford:   Appropriate  acronym. 

Blum:      It  sounded  good.   But  anyway,  nobody  put  up  real  money.   Alta 
Bates  put  up  something  like  twenty  thousand;  and  then  Herrick 
put  up  twenty  thousand.   It  is  ludicrous.   You  needed  about  a 
million  and  a  half,  or  two  million  dollars,  to  get  started,  and 
today  about  twenty  times  that. 

Crawford:   What  were  the  ramifications  of  setting  up  an  HMO? 

Blum:      Well,  in  the  first  place,  you  had  to  have  a  marketing  arm; 
somebody  had  to  sell  a  service  policy  to  industry  or  to 
government  and  other  big  employers  who  are  the  purchasers.   It 
was  very  clear  that  we  could  sell  it  to  the  two  hospitals  for 
their  employees.   If  they  founded  it,  they  would  provide  it  for 
their  own  employees,  but  even  they  were  reluctant  to  do  this, 


296 


Crawford: 
Blum: 


Crawford; 
Blum: 


as  HEALS  paid  them  less  per  patient-hospital  day  than  most 
other  HMOs  and  insurers. 

So  we  had  some  customers,  but  supposing  you  wanted  to  come 
to  the  university  to  sell  HEALS  insurance.   They're  the  biggest 
employer  around.   Well,  then  one  suddenly  needs  PR;  you  need  a 
whole  publicity  machine,  and  you've  got  to  set  up  the  business 
and  operations  side,  so  that  when  you  hand  out  materials, 
you're  able  to  say  how  you  work,  what  your  relationships  are, 
how  referrals  take  place,  what  doctors  are  used.   Before  that 
you've  got  to  sign  up  doctors,  and  you've  got  to  sign  up 
hospitals  and  set  up  the  machinery  to  take  in  the  purchasers' 
money,  direct  patients,  pay  doctors,  on  and  on. 

More  or  less  the  same  staff  doctors  you  had? 

Well,  remember  that  the  so-called  staff  doctors  didn't  work  for 
the  hospital.   They  were  all  in  private  practice,  and  many  of 
them  worked  in  two  or  three  hospitals.   So  you  had  to  get  them 
to  agree  to  take  HEALS  subscribers  as  patients.   You  had  to  get 
the  hospitals  to  do  so  also,  and  at  our  prices. 

So  first  you  had  to  develop  the  prices;  the  whole  bit,  and 
then  how  much  money  for  drugs?   How  much  could  you  expect?   How 
much  could  you  afford  to  pay?  How  about  the  business  side  of 
dealing  with  doctors  and  sending  them  their  money,  and  dealing 
with  the  hospitals  and  sending  them  their  money,  and  dealing 
with  patients  and  their  problems,  and  selling  memberships?   It 
was  a  tremendous  ground-up  effort,  and  essentially  done  with 
almost  no  money. 


Was  Kaiser  an  HMO  in  the  strictest  sense? 

Always.   Yes,  it  always  was,  and  not  for  profit, 
out  not  for  profit,  too. 


We  started 


We  ended  up  hiring  a  brilliant  administrator  named  Dennis 
McKenna  from  Kaiser  somewhere  down  in  the  Los  Angeles  area.   He 
was  a  young  hustler,  and  we  practically  lived  with  him.   There 
were  four  or  five  of  us--me,  Montgomery,  Manlove,  Jerry 
Kaufman,  McKenna- -hatching  the  program  at  all  these  stages,  and 
then  reaching  out  and  finding  somebody  to  do  the  selling, 
reaching  out  and  grabbing  somebody  to  do  the  PR,  then  getting 
business  types,  section  by  section,  for  drugs,  medical  care, 
hospital  care;  pulling  people  in  to  help  work  out  the 
negotiations  with  the  hospitals. 

We  had  to  negotiate  with  all  the  hospitals  around,  and  we 
finally  offered  our  plan  in  San  Francisco,  San  Mateo,  Santa 


297 


Clara,  Yolo,  Solano,  as  well  as  Alameda/Contra  Costa  counties. 
And  then  we  had  to  get  the  medical  societies  not  to  obstruct. 
They  hated  HMOs,  because  HMOs  had  meant  more  Kaiser  for  some  of 
them.   Most  welcomed  HEALS  which  used  only  private 
practitioners . 

Crawford:   And  it  meant  ceilings,  didn't  it,  on  private  practice  prices? 

Blum:      Well,  it  ultimately  would—at  least  it  would  interfere  with  how 
they  charged,  right  off  the  bat.   The  doctors  in  HEALS  were  not 
paid  on  an  annual  basis,  neither  per  patient  nor  by  salary. 
They  earned  the  money  on  a  fee-for-service  basis,  and  we  had  to 
negotiate  how  much  they  would  be  paid  for  every  single 
procedure.   We  had  to  negotiate:  how  much  for  a  tonsillectomy , 
an  examination  of  a  tonsil,  an  examination  of  an  eye,  a 
cataract—what  does  it  cost  to  remove.   Well,  you'd  borrow  such 
information  from  here  and  you'd  borrow  from  there,  and  you'd 
add  it  all  up,  and  how  many  of  these  will  there  be  per  patient, 
and  how  much  on  average  for  each  subscriber?   Because  that's 
how  much  you  have  to  charge  the  purchaser  for  each  employee 
they  would  insure  with  us. 

We  had  some  guidelines.   One  was  that  we  weren't  going  to 
be  much  more  expensive  than  Kaiser;  we  were  going  to  stay 
within,  maybe,  10  percent  of  Kaiser's  monthly  costs. 

Crawford:   Was  this  easy  to  do? 

Blum:      No.   You're  starting  up,  and  you  have  no  money;  there  is  no 
reservoir  of  bucks. 

Crawford:   All  you  have  is  your  physical  plant,  basically,  isn't  it? 

Blum:      You  don't  even  have  a  plant.   You  just  rent  an  office.   You  pay 
for  each  service  given  to  each  subscriber.   If  they  are  taken 
care  of  in  Pill  Hill,  or  here,  or  there,  or  elsewhere—there 
are  pre-negotiated  rates  at  which  hospitals  are  going  to  take 
care  of  them.   All  that  has  to  be  negotiated.   Everybody's 
giving  you  a  rough  time.   Everybody's  surviving. 

Dennis  was  a  bit  of  a  genius.   We  were  told  at  that  time 
and  everybody  knew  that  a  plan  had  to  be  nationwide.   Dennis 
really  felt  quite  differently,  and  persuaded  me,  that  you  had 
to  be  regionwide,  but  that  it  wouldn't  be  enough  just  to  be  in 
a  county,  that  we  had  to  be  regionwide  because,  for  example, 
Standard  Oil  has  a  plant  in  Richmond,  but  its  workers  go  home 
at  night  to  five  or  six  counties.   So  you've  got  to  be  in  those 
six  places.   Region  was  the  issue. 


298 


Crawford: 
Blum: 

Crawford: 
Blum: 


The  San  Francisco  Bay  Area  was  a  good,  sizeable  region;  the 
people  who  started  out  and  tried  to  go  national—most  of  them 
went  crazy.   Ultimately,  HMOs  kind  of  got  back  to  it. 

The  doctors  didn't  trust  us;  they  didn't  really  look 
forward  to  an  HMO,  but  many  of  them  did  put  in  twenty- five 
hundred  dollars,  which  would  be  theirs.   They  could  have  taken 
it  back  out;  they  got  stock,  ultimately,  for  it. 

Originally,  it  was  a  not-for-profit  plan  and  there  was  no 
stock.   What  we  did  was  withhold  on  every  doctor:  he'd  done 
various  services,  and  billed  for  them,  and  got  paid  for  them, 
but  he  wouldn't  get  all  of  his  money—he'd  get  80  percent  —  and 
the  remainder  would  be  held  in  a  pot  until  we  had  some  cash  to 
turn  around  with. 

When  you  start  out  with  just  a  few  hundred  doctors  and  four 
or  five  hospitals,  you  don't  have  much  volume.   That  withhold 
is  critical;  otherwise  you  can't  pay  your  bills.   We  were 
always  staggering  from  one  hour  to  the  next,  paying  our  bills. 
If  a  baby  was  born  prematurely,  we  practically  had  a  board 
meeting  over  it,  because  this  might  cost  you  thousands  of 
dollars  a  day— at  Children's  Hospital  in  the  East  Bay,  it  would 
cost  you  the  best  part  of  two  thousand  dollars  a  day. 

In  this  case  the  baby  may  stay  in  the  hospital  for  a  month, 
two  months,  three  months.   We  didn't  have  that  kind  of  money, 
so  it  was  one  long  hassle.   Yes,  we  could  have  gotten  better 
prices  in  San  Francisco  at  UCSF,  but  did  you  dare  ask  a  parent 
to  move  their  premature  infant  to  San  Francisco? 

All  these  things  were  quite  revealing.   We  went  through  a 
thousand  things,  so  we  were  always  negotiating  with  everybody 
over  everything.   Originally,  because  we  didn't  have  too  many 
customers,  the  hospitals  wouldn't  give  us  a  good  price,  nor 
would  the  pharmacists,  labs,  and  x-ray  people. 

What  was  HEALS1  range? 

Well,  we  started  out  in  Alameda/Contra  Costa,  and  then  moved  to 
the  whole  Bay  Area. 

Did  you  benefit  from  Kaiser's  expertise  in  this  area? 

Well,  in  the  sense  that  the  person  we  hired  to  head  it  up  was 
savvy  to  the  Kaiser  business  operations. 


Crawford:   Were  they  resistant  to  what  you  were  trying  to  do? 


299 


Blum:      No,  it  was  just  a  matter  of  business  —  they  're  going  their  way, 
you're  going  yours.   Kaiser  is  so  big  that  it's  hard  to  say 
that  they  were  resistant  to  anything,  or  cared.   Half  the  docs 
here  were  ex-Kaiser  docs  —  in  this  area  that's  how  you  proved 
that  you  were  a  good  doctor;  you  left  Kaiser.   It's  kind  of 
interesting;  it  really  tells  you  that  Kaiser  must  have  been 
pretty  good  in  the  first  place. 

So  our  own  doctors  did  us  no  favors,  and  they  still  went  on 
overdoing,  overdoing,  over-prescribing.   Instead  of  generic 
drugs,  they'd  go  for  trade  names.   The  difference  in  price 
might  be  five-fold. 

We  had  committees  of  physicians,  and  the  place  was  run  by 
doctors,  really,  because  in  the  long  run,  they  write  the 
prescriptions,  they  send  the  hospital  the  patient.   But  it 
turns  out  that  it's  very  hard  for  a  doctor-run  organization  to 
stick  by  their  guns.   In  other  words,  if  they  see  a  doctor 
who's  wasting  procedures  or  doing  unnecessary  surgery,  it's 
very  hard  to  step  over  and  say,  "John,  my  old  friend,  you're 
going  to  have  to  knock  it  off.   You  can't  be  doing  that."  And 
they  didn't  succeed  at  controlling  needless  services.   We'd 
always,  year  after  year,  lose  a  half  a  million  bucks,  one  way 
or  another.   But  that's  chicken  feed  because  our  revenues  were 
a  hundred  million  almost  overnight.   The  HMO  grew  fast. 

Crawford:   Who  absorbs  the  loss? 

Blum:      You  don't.   It  just  stays  on  the  books.   Or  that  20  percent  the 
doctors  are  supposed  to  get  back?  Well,  they  don't  get 
anything  back,  and  that  20  percent  is  used  to  make  the 
organization  solvent.   It  teaches  the  doctors  just  the  wrong 
thing,  that  they  had  better  grab  their  money  and  run,  because 
they're  only  going  to  get  80  percent  of  what  they  think  they're 
going  to  get.   So  there  are  many  kinds  of  incentives  in  the 
picture.   The  withhold  worked  just  the  opposite  to  what  it  was 
supposed  to  do,  that  is,  encourage  thriftiness  so  you  could  get 
it  back. 

I  remember  just  a  year  or  two  ago  I  went  to  see  a  man  whose 
father  had  been  a  doctor  in  my  day  at  HEALS,  and  he  said,  "I 
remember  your  name.   You  were  involved  in  HEALS?"   I  said, 
"Yes,  I  sure  was."  He  said,  "The  doctors  really  kind  of  ruined 
that,  didn't  they?" 

Well,  that's  exactly  true,  by  not  watching  out  for 
avoidable  costs.   Instead  of  HEALS  becoming  more  and  more 
valuable,  it  was  really  starting  to  build  up  debt.   So  it  was 
sold  to  QualMed.   QualMed  became  HealthNet,  and  now  HealthNet 


300 


and  somebody  else  are  going  together, 
monsters,  now. 


It's  one  of  the 


The  doctors  were  in  a  position  to  make  it  or  break  it,  and 
they  were  very  casual  about  breaking  it.   They  didn't  see  it 
was  in  their  own  interest  to  make  it  successful.   They  would 
never  get  it  into  their  heads  that  HEALS  was  detouring  patients 
to  them  who  would  otherwise  have  gone  to  somebody  else.   For 
instance,  the  first  year  HEALS  was  offered  here  at  UC  Berkeley, 
we  outsold  Kaiser.   That's  unbelievable.   And  all  those  persons 
who  shifted  to  us  from  Kaiser  meant  new  patients  for  our 
doctors . 

Crawford:   That  is  unbelievable.   Was  that  the  force  of  your  marketing  or 
discontent  with  Kaiser? 

Blum:      Well,  both.   In  the  first  round,  you  will  get  the  discontented 
people.   Secondly,  our  price  was  very  close  to  Kaiser's,  so 
that  the  university  agreed  to  pay  for  it.   The  patients  then 
have  the  chance  to  get  their  own  doctor  and  go  to  Alta  Bates 
and  not  to  Kaiser  and  not  to  Kaiser  Hospitals  —  and  the  price  to 
them  was  identically  zero.   In  fact,  the  university  absorbed 
the  difference.   You  didn't  have  to  pay  anything  for  this. 

Crawford:   How  did  you  get  the  university  to  go  with  HEALS? 

Blum:      It  was  a  bargain.   But  it  took  a  little  talking,  I  will  say. 

Crawford:   Did  you  lobby  for  it? 

Blum:      Not  really,  because  as  a  faculty  person,  that  wouldn't  look  too 
good.   Dennis  McKenna,  our  chief  operator—our  guru—did  it 
with  assistance  from  other  people,  but  it  was  obviously  the 
thing  to  do.   So  HEALS  was  really  a  wild  success  here. 

Crawford:   How  long  was  your  involvement  with  it? 

Blum:      Quite  a  long  time.   In  the  course  of  a  few  years,  I  became 
chairman  of  the  board,  and  I  was  chairman  for  quite  a  few 
years.   I  was  chairman  from  "84  to  "87,  as  I  said,  and  it  had 
taken  almost  a  decade  to  set  it  up. 

Crawford:   People  complain  because  the  hospital  stays  are  so  short  now.   I 
think  a  mastectomy  is  almost  an  outpatient  procedure. 

Blum:      It  can  be.   Well,  in  those  days,  the  first  thing  we  did  was 

compare  drug  use,  compare  hospital  stays,  and  so  on.   The  deal 
we  had  with  Alta  Bates  was  paying  them  so  much  a  day,  in  the 
hospital.   It  had  nothing  to  do  with  how  long  you  stayed,  they 


301 


got  paid  for  each  day.   Now  it  hardly  works  that  way.   Usually, 
the  hospital  gets  paid  per  case,  and  the  shorter  the  stay,  the 
happier  everybody  is;  but  Medicare  really  started  that.   But  if 
physicians  aren't  watchful,  or  don't  give  a  damn,  they 
authorize  a  day  more,  and  in  HEALS"  time,  you  start  looking  at 
more  days  and  days,  more  drugs  and  drugs,  more  procedures  and 
procedures.   A  lot  of  procedures  aren't  really  necessary. 

The  HEALS  committees  always  talked  great,  but  they  really 
didn't  do  that  much.   When  HEALS  was  sold  to  QualMed,  I  got 
sixty-five  dollars  for  my  one  share.   It  wasn't  one  of  those 
deals  where  you  sold  because  the  directors  made  great  money. 
Quite  the  contrary,  we  made  nothing,  but  QualMed  picked  us  up 
when  we  were  probably  losing  a  half  million  dollars  a  year,  at 
least. 

The  first  year  QualMed  is  supposed  to  have  netted  ten 
million  dollars  on  the  same  operation.   QualMed  took  the  same 
premiums,  same  docs,  same  hospitals,  same  prices,  same  drugs; 
and  it  turned  a  ten-million-dollar  profit. 

Crawford:   How? 

Blum:      It  was  now  a  for-profit  venture.   It  had  become  a  for-profit 
venture  in  my  time  for  various  reasons;  really  had  no  choice, 
mostly  because  it  was  losing  money.   QualMed  hired  three  bright 
young  docs—one  for  every  thirty-five  thousand  customers  (about 
a  hundred  thousand  customers) --and  they,  not  the  clerks, 
scrutinized  all  transactions  that  amounted  to  anything. 


Crawford:   Smart. 

Blum:      Well,  those  three  docs  cost  QualMed  half  a  million  dollars 

between  them  a  year,  and  they  saved  ten  million.   Just  their 
presence  had  already  changed  the  attitude  of  what  doctors  were 
going  to  prescribe,  because  they  knew  they'd  get  called  if  they 
were  prescribing  something  or  doing  a  procedure  that  was 
uncalled  for. 

Crawford:   In  front  of  a  peer? 

Blum:      That's  right,  in  front  of  a  hot,  young  peer,  who  knew  as  much 
or  more  than  they  did,  almost  for  sure.   I  don't  know  how 
QualMed  operated  after  that,  but  that's  how  they  started.   I 
stayed  on  as  a  consumer  after  1987. 

Crawford:   The  care  was  good? 


302 


Blum: 

Crawford: 
Blum: 


Just  the  same  care,  same  docs,  same  hospital,  same  everything, 
but  the  needless  crap  was  gone. 


Crawford; 
Blum: 

Crawford; 
Blum: 


Crawford; 
Blum: 


So,  all  on  balance,  a  success? 


But 


Totally.   I'm  sure  that  QualMed  never  regretted  buying  us. 
the  point  I'm  making  is  that  no  one  doctor,  from  his 
standpoint,  could  see  that.   What  he  kept  overlooking  was, 
"Never  mind  your  take-home,  you  won't  have  any  patients  if  you 
don't  have  an  organization  to  compete  with  Kaiser,  because 
everybody  is  going  to  Kaiser."  That  was  the  way  it  was.   The 
bulk  of  the  patients  that  weren't  county  patients  were  in 
Kaiser,  that's  that.   There  were  a  certain  number  in  Medicare, 
too,  of  course,  and  Medi-Cal,  but  it  was  Kaiser.   If  you  let 
that  go  on,  you  wouldn't  have  a  practice. 

Before  HEALS  started,  at  that  point,  many  of  the  docs  that 
we  knew  had  just  left  private  practice  and  gone  to  Kaiser. 
Things  were  that  tough.   Or,  in  some  cases,  had  gone  to  the 
county,  because  there  were  hard  times,  and  many  people  didn't 
have  the  wherewithal,  so  they  went  to  the  county  as  patients. 
Well,  the  doctors  had  to  go  somewhere,  and  they  went  to  county 
or  they  went  to  Kaiser,  where  their  patients  had  gone. 

It  seems  that  Kaiser  has  very  simplified  billing  procedures. 

When  I  go  to  the  hospital,  you  should  see  the  list  of  crap  that 
comes  out  with  the  charges. 

Exactly. 

Well,  in  Kaiser,  there's  no  such  nonsense:  You're  on  this  ward? 
All  right,  that's  worth  eight,  nine  hundred  dollars  to  the 
internal  Kaiser  bookkeeping,  but  the  patient  never  sees  that. 
You've  been  paid  for,  and  you're  done.   They  don't  waste  their 
time  or  yours  getting  your  money. 

That's  very  streamlined,  in  that  sense. 

Very  streamlined.   So  their  administration  costs  are  about  3,  4 
percent,  and  everybody  else's  plan  is  probably  15  or  20,  you 
see.   That's  still  true,  although  other  plans  are  commencing  to 
catch  on.   Many  have  streamlined  themselves  to  the  10  percent 
mark.   The  little  HMO  that  Contra  Costa  County  runs  that  was 
starting  when  I  left—wasn't  my  doing,  but  it  was  a  good  idea- 
runs  at  6  or  7  percent. 

For  instance,  our  overhead  at  HEALS  was  monstrous  when  we 
started--it  was  25  percent.   Of  course,  there  are  still  big 


303 


insurance  companies  that  run  that  way.   They're  taking  that 
money  out  of  it,  but  the  point  is  that  the  development  of  one 
ad,  or  the  development  of  a  billing  form,  if  you  use  it  for  two 
million  customers,  is  a  lot  cheaper  per  customer  than  using  it 
for  twenty  thousand.   Contra  Costa  County  managed  to  do  it  for 
twenty  thousand  persons,  and  do  it  almost  as  cheaply  as  Kaiser 
with  thirty  times  as  many  subscribers. 

Well,  in  HEALS'  first  year,  we  were  scared  to  death--!  mean 
a  25  percent  overhead,  but  you  knew  there  was  no  choice.   You 
had  to  negotiate  with  every  single  employer.   You  had  to  go 
back  and  convince  them  to  buy  our  product,  that  we  were  here  to 
stay.   Our  doctors  and  hospitals  were  known  quantities,  and 
that  helped. 

And  the  next  year  it  dropped  to  about  20  percent,  and  that 
was  quite  a  relief.   And  then  it  dropped  to  about  15  percent, 
and  then  it  dropped  to  about  12.   When  you  got  through  the 
newness  and  the  development,  and  then,  secondly,  you  spread  it 
over  a  hundred  thousand  customers,  not  over  five  thousand,  that 
downward  shift  in  overhead  costs  was  exciting. 

Crawford:   I've  been  reading  about  Alta  Bates'  new  birthing  center.   How 
did  they  have  the  financial  resources  to  develop  this? 

Blum:      Hospitals  have  lots  and  lots  of  money.   Money  runs  through, 
runs  through.   On  the  other  hand,  even  as  they  have  lots  of 
money,  they  could  be  going  broke.   Herrick,  before  they  were 
partnered  with  Alta  Bates,  spent  twenty,  thirty  million 
building  a  new  hospital.   And  Alta  Bates  proceeded  to  get 
thirty  million  bucks  to  do  the  same  sort  of  thing.   They  were 
just  competing  with  one  another  for  no  purpose.   Berkeley 
needed  one  of  the  two,  but  not  both.   Well,  this  is  where  the 
monies  go,  you  see. 

Crawford:   So  they  were  always  competing? 

Blum:      Not  since  they  merged,  no  more  duplication  of  facilities  and 

staffs.   When  Bob  Montgomery  left  Alta  Bates  for  ten  years,  he 
was  followed  by  people  that  were  unbelievable.   I'll  never 
forget;  I  had  a  hand  in  picking  them  out.   We  weren't  very 
bright. 

In  1983,  we  had  a  welcoming  party  for  the  new 
administrator.   My  wife  went  with  me  to  the  fancy  little 
soiree,  and  when  we  left,  she  said,  "Who  was  that  tall  guy?"   I 
said,  "Well,  that's  the  new  administrator."   She  said,  "Oh,  no, 
you  couldn't  have  picked  him?  You're  going  to  die  with  that 


304 


guy."   She  did  personnel  work,  years  ago,  of  all  places,  for 
Kaiser  at  Walnut  Creek  when  they  were  new. 

Crawford:   Oh,  really?   For  many  years? 

Blum:       Several  years;  it  was  a  part-time  job,  no  big  deal.   She's  one 
of  those  people  who  sizes  up  people.   She's  always  said  she 
should  have  been  the  doctor  in  the  family.   She  wasn't  wrong  on 
this  guy,  either.   We  got  the  biggest  bluffer  you  ever  saw. 

Crawford:   Had  he  come  from  this  program? 

Blum:      No,  no,  god  knows  where  he  came  from.   He  used  to  say  that  he 
was  a  minister's  son.   He'd  been  trained,  though. 

But  he  managed  to  get  rid  of  that  thirty  million  bucks  —  or 
most  of  it—without  anything  to  show  for  it.   He  was  just  a  big 
operator,  and  he  literally  almost  killed  HEALS.   Under  his 
initiative,  Alta  Bates  suddenly  decided  to  take  it  over  and  own 
it.   They  came  in  with  some  idiotic  claim  that  they  owned  87 
percent  of  it,  and  they  were  going  to  start  writing  the  ticket. 
This  was  when  it  was  really  growing  like  mad,  and  looking  very 
prosperous . 

We  added  it  all  up,  and  the  only  thing  he  had  overlooked  — 
and  this  is  this  guy's  business  training—was  the  fact  that  the 
docs  had  never  been  getting  their  20  percent,  and  that  means 
that  they  had  been  investing  their  20  percent  in  the  plan,  and 
their  ownership  was  like  97  percent,  if  you  wanted  to  get  down 
to  brass  tacks.   They  owned  the  whole  thing,  dollar-wise.   So 
here  they  were  —  and  their  hospital  was  trying  to  steal  it. 

So  it  came  to  quite  an  impasse.   We  were  switching  to  for- 
profit,  because  if  you  weren't  for-profit,  and  you  needed  to 
borrow  money,  you  could  only  go  to  the  bank,  or  something 
comparable,  and  there's  only  so  much  you  can  borrow  at  the  bank 
without  being  choked  to  death  on  10  percent  interest.   We 
started  converting  to  for-profit  so  we  could  sell  stock  and 
raise  money  that  way,  and  Alta  Bates  wouldn't  let  us  convert. 
Oh,  did  we  have  a  time  with  Alta  Bates.   We  hired  lawyers,  we 
did  this,  we  did  that,  and  we  finally  got  out  from  under  their 
clutches,  and  then  went  independent. 

Crawford:   What  happened  to  your  administrator  at  HEALS? 

Blum:      He  was  bounced  out  at  the  same  time.   It  would  be  hard  to 
defend  him,  although  I  sort  of  did,  because  he  was  just 
brilliant  about  the  strategy  of  the  thing— about  which  way  to 
turn  on  the  big  scene— but  internally,  he  was  a  poor 


305 


administrator.   So  he  had  to  go,  and  when  I  was  gone  that  was 
the  end  for  him. 


Crawford: 
Blum: 


At  one  point,  he  discovered  that  we  were  double  paying  for 
x-ray.   Every  time  a  patient  got  x-rayed  in  Alta  Bates,  it  was 
included  in  the  bill  as  an  extra,  but  then  we'd  get  separate 
repeat  bills  from  x-ray.   It  was  a  half  million  dollars  per 
year,  and  I  don't  think  it  was  accidental,  because  every  kind 
of  problem  we  had  with  Alta  Bates  was  always  the  same  way. 

Well,  the  idiotic  thing  is  that  Alta  Bates  has  now  had  to 
reproduce  HEALS.   Alta  Bates  has  a  medical  group,  and  they  are 
back  where  they  were  when  they  had  HEALS--they  have  a  similar 
kind  of  organization,  but  now  the  doctors  are  mostly  per 
capitated. 

Oh,  they  didn't  go  with  HEALS? 

No,  although  Alta  Bates  was  the  key  force  in  setting  it  up, 
they  tried  to  steal  it,  so  HEALS  went  on  its  own  way.   We  used 
Alta  Bates  as  a  hospital,  but  Alta  Bates  was  no  longer  in 
HEALS,  to  speak  of.   They  may  have  owned  a  few  shares  of  stock 
because  of  their  original  twenty-thousand-dollar  investment. 
They  were  pretty  horrible  to  do  business  with.   They,  too, 
couldn't  even  realize  that  if  they  lost  HEALS,  they'd  lose  a 
lot  of  customers  to  Kaiser. 


Well,  anyhow,  all  this  you  learn,  and  when  you're  teaching, 
it's  nice  to  know  what  you're  doing. 

Crawford:   How  did  this  affect  your  teaching? 

Blum:      Oh,  it  was  wonderful.   You  work  longer  hours,  but  you're  just 
picking  up  all  sorts  of  information  all  the  time,  and  nobody 
else  even  knows  what's  going  on.   Now  a  lot  of  people  know 
those  things,  but  in  those  days,  where  were  you  going  to  read 
about  it?   Five  years  later,  somebody  will  write  an  article  on 
it,  which  might  or  might  not  be  to  the  point.   But  you're 
really  living  it. 

Of  course,  we  were  constantly  negotiating  with  other  HMOs, 
sharing  territory  and  considering  joining  forces—so  you  were 
in  everybody's  backyard,  and  you  knew  all  the  businesses  up  and 
down  the  whole  Bay  Area,  and  there  were  many  HMOs  in  the  Bay 
Area. 

Crawford:   This  was  the  time  when  they  were  being  established? 


306 


Blum:      Being  established,  yes.   If  we  weren't  in  them,  we  were 

negotiating  with  them.   If  we  weren't  negotiating  with  them,  we 
were  surely  watching.   So  we  knew  all  kinds  of  things.   Well,  I 
thought  it  was  the  difference  between  knowing  what  you  were 
teaching  and  just  teaching. 

Crawford:   You  were  really  training  these  public  policy  students,  weren't 
you? 

Blum:      Oh,  yes,  at  the  same  time,  and  many  of  them  went  into  these 
operations.   Part  of  our  training  was  always  something 
practical.   When  I  became  the  professor  of  health  policy--! 'd 
been  in  health  planning  before  the  mid-seventies--all  the 
students  had  to  work  in  the  field  while  they  were  going  to 
school.   This  was  not  as  an  internship—but  they  had  to  honest- 
to-god  pick  up  a  project  and  run  with  it  as  part  of  class  work. 
Thanks  to  Len  Duhl,  who  had  a  lot  of  connections  in  the  state 
legislature,  many  of  our  students  worked  in  Sacramento  for  the 
assembly  or  the  senate  or  the  governor's  offices.   They  were 
full-time  students,  but  as  part  of  our  course  work  they  were 
doing  projects  for  the  organization  that  they  were  assigned  to. 
They  had  fantastic  experiences,  and  many  of  them  ended  up 
there.   Just  the  other  day  I  saw  several  who  are  still  there. 
This  was  at  the  state  health  department.   There  were  at  least 
half  a  dozen  at  this  one  meeting.   In  many  cases,  their  job 
resulted  from  the  project  that  they  had  worked  on  as  a  student. 

Every  so  often  the  students  had  to  report  to  their 
assembled  class.   That's  how  we  operated.   It  would  be  teams  of 
two  to  five  people—usually  three  or  four  —  and  they'd  work  up 
there,  and  divvy  up  the  tasks,  and  I  didn't  have  that  much  to 
do  with  it.   They  did  it,  and  then  they'd  come  back  and  fill  us 
in.   We  would  give  them  two  hours  to  bring  us  up  to  date  on 
where  their  team  was,  what  they  were  doing.   So  all  of  us 
learned  all  kinds  of  things  about  how  our  state  government 
operated  and  what  it  was  up  to. 


307 


VIII   INTERNATIONAL  FIELD  SERVICE:  1969-1981 


Dr.  Hilleboe  and  the  World  Health  Organization 


Crawford:   Today  we're  going  to  talk  about  your  international  work  to 
date.   How  did  you  get  started  in  field  work? 

Blum:      I  had  had  a  good  experience,  because  planning  was  new,  and  I 
was  in  charge  of  that  program  in  the  School  of  Public  Health 
because  nobody  else  knew  what  to  do  with  it.   It  was  assumed 
that  anybody  in  public  health  knew  all  about  planning--!  think 
I  said  that  already—and  it  turned  out  we  didn't  know  anything 
about  it.   We  had  only  done  planning  internally  inside  of 
organizations,  which  is  a  very  simple  matter  with  a  set  of 
objectives,  usually  mandated  in  law.   When  you  deal  with  a 
community,  whether  it  be  a  city  or  a  county  or  a  state  or  a 
country,  the  objectives  commence  to  be  pretty  diffuse,  and  to 
plan  is  no  small  matter. 

Each  year,  I  got  out  a  little  textbook.   It  was 
mimeographed  and  put  out  by  the  Western  branch  of  the  American 
Public  Health  Association.   It  was  done  at  cost,  so  whoever 
bought  the  book  paid  for  whatever  it  cost—a  couple  of  dollars 
--but  each  year  it  got  bigger  and  bigger  and  finally  ended  up 
being  my  book  on  health  planning.   Originally  it  started  out 
with  a  lot  of  other  contributors  because  I  really  hadn't  had 
the  breadth  before. 

By  happenstance,  there  were  some  real  problems  at  the  UCLA 
School  of  Public  Health  in  the  late  sixties,  and  the  dean  there 
invited  me  down  to  live  through  the  problems  with  them.   We 
ended  up  with  a  two-day  session  with  a  man  by  the  name  of 
Herman  Hilleboe.   He  was  an  assistant  surgeon  general  in  the 
U.S.  Public  Health  Service,  and  he  was  supposed  to  have  become 
the  next  surgeon  general  of  the  U.S.  Public  Health  Service,  if 
and  when  Dewey  became  president. 


308 


Crawford: 
Blum: 


Herman  Hilleboe  was  picked  up  by  Governor  Rockefeller  and 
brought  to  New  York  as  director  of  the  New  York  State  Health 
Department  when  Dewey  fell  by  the  wayside.   He  was  a  sharp, 
smooth  article;  a  very,  very  bright  person.   Lester  Breslow-- 
who  was  the  dean  at  UCLA--invited  me  and  Herman  Hilleboe  to 
spend  a  couple  of  days  with  him,  looking  at  health  planning, 
and  we  just  worked  from  dawn  to  dusk  and  argued  beyond,  and 
Herman  Hilleboe  could  never  understand  what  I  was  doing, 
because  he'd  always  been  an  in-house  or  administration  planner. 

He  said,  "The  governor  wants  this,  so  you  figure  out  how  to 
give  him  this."  But  the  crux  of  the  matter  is  that  useful 
health  planners  don't  work  that  way.   They  have  to  figure  out 
for  the  governor  what  it  is  that  the  governor  should  want.   If 
you're  really  a  health  planner,  you  have  to  figure  out  what  a 
society  or  a  legislature  or  somebody  else  needs.   You  don't 
have  all  the  instructions  about  what  you  are  to  do  all  handed 
down.   Typically,  the  state  health  officer  has  a  job  where  it's 
all  written  down.   He's  got  to  be  smart  enough  to  make  it 
happen.   It's  quite  different  to  be  smart  enough  to  say  what 
ought  to  happen  in  the  first  place—who's  going  to  make  what 
laws  under  what  circumstances  —  that '  s  the  job  for  a  health 
planner.   In  reality,  without  recognizing  the  nature  of  the 
task  as  being  one  of  health  planning,  health  officers  had 
always  done  this,  but  without  benefit  of  understanding  much 
about  planning  as  a  skill. 

Well,  Herman  Hilleboe  could  not  understand  this.   He'd  been 
so  busy  all  his  life  in  the  midst  of  administrative  and 
organizational  planning  that  he  thought  that  was  all  there  was 
to  it.   Hilleboe  was  also  the  key  advisor  to  the  director 
general  of  the  World  Health  Organization,  although  he  didn't 
work  for  WHO  on  a  regular  basis.   He  left  Los  Angeles  for 
Geneva  and  his  WHO  desk  when  our  little  meeting  was  over. 

That's  unusual,  isn't  it? 

No,  there  were  quite  a  few  such  people  in  the  history  of  the 
WHO,  but  he  was  the  key  one  in  my  time. 

So  when  we  finished  our  meeting  in  Los  Angeles,  I  gave  him 
a  copy  of  the  book.   I  remember  it  was  a  nice  persimmon  color, 
an  eight-and-a-half-by-eleven-size  paperback.   I  asked  him  to 
look  at  it  on  the  plane--"You  may  finally  understand  what  I'm 
trying  to  say." 

Then  in  a  matter  of  sixty  or  ninety  days,  I  get  a  call  from 
the  World  Health  Organization  to  please  come  and  do  an 


Crawford: 
Blum: 


Crawford: 
Blum: 


309 


examination  of  a  program  of  theirs.   It  was  a  special 
committee,  and  we  had  to  publish  our  recommendations. 

What  was  the  program? 

It  was  an  epidemiologic  program,  and  it  was  run  by  a  scientist 
who  was  kind  of  a  maniac,  and  he  kept  destroying  it.   I  never 
understood  why,  because  it  was  a  potentially  wonderful  thing. 
We  tried  to  change  it  all  around  and  we  did,  but  they  couldn't 
make  it  work  with  that  guy  in  charge.   They  had  to  finally  send 
him  off  somewhere  and  ended  the  program. 


Do  you  remember  his  name? 

No,  it  was  a  nice  English  name. 
Australia  or  some  place. 


He  was  from  New  Zealand  or 


So  I  get  this  request  to  be  the  person  who  writes  up  the 
f indings--the  rapporteur- -meaning  you  not  only  participate  but 
you  write  up  all  the  conclusions. 

Crawford:   This  was  in  Rome? 

Blum:      No,  this  was  in  Geneva  at  WHO  headquarters.   I  got  there,  this 
was  1969,  and  I  discovered  that  there  was  a  message  waiting  for 
me  to  please  go  see  Dr.  Bennett.   I  don't  know  Dr.  Bennett,  but 
the  first  thing  I  see  on  his  desk  is  my  persimmon  book.   It  was 
hardly  used  anywhere,  just  for  our  own  use  around  here,  so  I 
couldn't  believe  it. 

He  came  in  and  said,  "You  don't  remember  me?   I  used  to  be 
a  student  of  yours  while  you  were  at  Stanford."  He  said,  "I 
also  worked  in  your  health  department.   I  did  an  experiment  to 
see  if  the  hookworm  could  propagate  and  infect  people  down  in 
the  Walnut  Creek  to  San  Ramon  area." 


Then  I  remembered  this  kid.   He's  a  tall  handsome  guy  now. 
Here  he  is,  at  WHO,  one  of  the  bright  young  men  there,  and  he's 
got  my  book.   I  said,  "How  did  you  get  this  book?"  He  said, 
"Oh,  everybody  here's  got  it.   You  know  Herman  Hilleboe,  Dr. 
Hilleboe?  Well,  when  he  came  here,  this  summer,  to  work,  this 
was  on  his  desk.   So  everybody  here  figured  we  had  to  get  one." 
[laughter] 

Hilleboe,  I'm  sure,  had  never  read  it.   Hilleboe  was  still 
there,  too.   But  it  was  funny  because  if  Hilleboe  did 
something,  it  became  sacred  at  WHO. 

Crawford:   Everyone  had  to  have  your  book. 


310 


Blum: 

Crawford; 
Blum: 


Oh,  yes--so  that's  how  I  got  my  start  with  WHO--through 
disagreeing  with  Hilleboe,  who  then  took  my  book  and  probably 
never  looked  at  it,  but  left  it  on  his  desk. 


That  was  1970? 

Yes,  it  was  about  1970. 
friends. 


That  was  Herman  Hilleboe.   We  became 


Working  with  WHO  in  Sri  Lanka;  1970 


Blum:      Then  three  or  four  assignments  all  occurred  at  the  same  time. 

I  went  to  Sri  Lanka  at  their  request.   That  was  an  interesting, 
fascinating  experience.   I  got  there,  I  think,  six  weeks  after 
Madame  Bandaranaike  was  made  prime  minister  again.   It's  a 
Commonwealth  country,  an  amazing  country.   They  had  better 
literacy  than  we  do  and  are  educated  in  the  British  tradition; 
a  kind  of  humanities  tradition.   They  were  very  expert  at 
Shakespeare,  but  what  they  really  needed  were  some  mechanics 
and  some  people  who  could  run  and  build  railroads  and  dams  or 
businesses,  and  they  didn't  train  those  kinds  of  people. 

We  got  there  just  a  few  days  after  a  minor  revolt  that 
occurred  when  Mme.  Bandaranaike  was  again  elected  prime 
minister.   It  was  supposedly  brought  about  by  upper-level 
college  students  who  saw  no  jobs  ahead  of  them.   Unemployment 
was  rife,  yet  the  people  were  98  or  99  percent  literate  with  a 
good  humanities-type  education. 

Everything  seemed  very  peaceful  to  us  but  major  changes 
were  introduced:  all  teaching  and  transactions  were  to  be  done 
in  either  Tamil  or  Sinhalese.   However,  the  80  percent  dominant 
majority  was  Sinhalese  and  this  upper-class  element  who  made  up 
most  of  the  country's  leadership  no  longer  knew  much  Sinhalese, 
depending  entirely  on  English  and  were  disadvantaged  for  the 
moment.   This  turned  out  not  to  be  practical,  but  it  left  a 
sense  of  the  government  attempting  to  be  fair.   This  also 
tended  to  turn  the  tide  towards  the  less  well-off  17  percent 
who  were  Tamils  and  knew  Tamil  as  well  as  English. 

Then  one  afternoon,  she  changed  the  money,  and  you  couldn't 
get  more  than  something  like  ninety  new  dollars  for  your  old 
ones  if  they  were  not  in  usual  businesses.   So  if  you  had  a 
million  dollars  at  home,  all  that  money  was  valueless.  You 
couldn't  give  it  away.   Folks  that  had  been  hoarding  it  and 
shipping  it  out  of  the  country  were  caught  flat-footed.   There 


311 


was  nothing  you  could  do  with  the  old  money—you  could  paper 
the  walls.   That  took  a  lot  of  guts. 

Then  she  appointed  all  the  ministers,  who  were  all  new  when 
I  got  there.   The  minister  of  health  that  I  worked  for,  helping 
him  plan  for  his  services,  was  a  country  general  practitioner 
in  his  thirties  from  Randy.   There  are  wonderful  place  names  in 
that  country- -K-A-N-D-Y.   It's  hill  country,  and  an  old 
Sinhalese  stronghold,  and  very,  very  beautiful,  I  must  say. 

The  first  thing  he  asked  me  to  do  was  lay  out  a  health 
sector  plan.   I  said,  "I  want  a  meeting  with  all  the  other 
national  department  heads  or  ministers,  or  the  chief  officers. 
I  would  like  to  hear  what  you  people  think  your  country  is  all 
about.   I  have  to  get  some  sense  of  where  people  want  to  go. 
I'm  willing  to  give  you  a  sheet  with  my  notions  of  your 
priorities,  because  I'm  reading  your  papers  like  mad,  but 
that's  just  my  opinion  of  what  I  read."  Then  I  said  I  wanted 
to  get  some  information  on  the  planning  that  had  been  done  for 
the  physical  aspects  of  the  country,  and  the  economics  of  the 
country—everything  but  health.   He  told  me  the  planning 
department  of  the  national  government  was  in  the  finance 
department . 

I  had  just  gone  to  a  party  the  night  before;  a  party  in  a 
neutral  zone,  a  place  where  the  Poles  and  the  Russians  and  the 
Koreans  and  the  Chinese  could  also  meet  with  all  the  other 
Europeans.   I  forget  whose  party  it  was;  maybe  Poland's.   There 
were  people  there  from  every  country  in  the  world  who  were 
working,  developing  that  poor  country. 

A  Sri  Lankan  came  up  and  said  to  me:  "I  understand  that 
you're  here  to  help  plan  for  the  health  sector.   Well,  I  hope 
you're  not  one  of  those  idiots  who's  going  to  tell  us  to  build 
more  beds  and  more  hospitals  and  train  more  doctors."   I 
wasn't,  to  be  sure.   He  said,  "You  know,  I've  made  a  tour  of 
our  hospitals  and  looked  at  the  records.   Do  you  know  that  50 
percent  of  the  cases  that  are  admitted  to  the  two  major 
hospitals  in  this  country  are  there  because  of  contagious 
disease  spread  by  dirty  water?  That's  inexcusable.   Why  do  we 
even  need  hospitals?  Why  in  the  hell  don't  we  clean  up  the 
water?  What's  a  health  department  for?" 

This  was  a  planner  from  the  finance  ministry,  and  so  I 
realized  I  wasn't  going  to  have  too  much  trouble  with  those 
people.  He  made  a  lot  of  sense. 

So  I  had  an  entree  as  of  that  party,  and  then  the  minister 
of  health  asked  me  what  I  wanted  to  know.   I  said,  "I  want 


312 


about  twenty  items.   For  example,  I  want  to  know  what  the 
picture  was  for  education  by  the  various  grades  for  1960,  what 
it  is  right  about  now,  or  what  it  will  be  in  1980  and  probably 
in  1990,  because  you  are  getting  ready  to  have  one  of  the 
world's  largest  irrigation  projects." 

The  Mahelevi  River  was  being  dammed,  and  they  were  going  to 
irrigate  the  highlands,  and  turn  it  into  a  Sacramento  Valley. 
I  don't  know  if  it  ever  happened.   I  should  go  back  and  find 
out. 


Then  I  asked  for  all  the  water  f igures--what  proportion  of 
the  people  were  going  to  get  clean  drinking  water,  what 
proportion  dirty  water;  what  proportion  were  going  to  have 
electricity.   This  is  health,  you  know,  it's  not  just  about 
building  a  hospital.   I  asked  about  the  roads  and  the 
transportation.   It  was  a  country  with  good,  very  cheap 
transportation  all  over. 

Crawford:   The  English  are  responsible  for  that? 

Blum:      I've  never  been  inclined  to  give  the  British  too  much  credit 

for  anything  because  of  the  disastrous  things  they've  done,  but 
I  guess  so.   You  could  say  so.   Even  the  big  buses  around  town 
were  all  two-deckers  that  couldn't  be  used  anymore  in  England, 
but  a  Sri  Lankan  can  fix  anything.   It's  another  one  of  those 
countries  with  so-called  backward  people  that  can  do  all  kinds 
of  things  if  they  are  allowed  to. 

I  found  out  what  proportion  of  the  people  would  be  working 
in  agriculture,  what  proportion  in  other  fields.   You  get  down 
to  the  basics  of  who  is  going  to  be  healthy  if  you  start 
unraveling  these  questions. 

I  was  invited  over  to  the  finance  ministry,  and  they  sat  me 
down  in  an  auditorium,  and  they  said,  "Okay,  the  first  thing 
you  want  to  know  is  about  water."  That's  the  one  that  scared 
me  the  most,  because  that  could  really  wipe  the  country  out 
with  dirty  water  which  would  be  provided  for  the  expected  huge 
population  coming  into  the  areas  to  be  irrigated  from  the  new 
dam. 

They  pulled  this  big  chart  across  the  stage.   It  had  a  wood 
frame,  and  it  was  about  eight  feet  high,  and  eight  feet  wide. 
Here  were  the  charts  of  water,  and  the  proportions  of  people 
and  usage—the  things  I'd  asked  for,  they  already  had  it  worked 
out. 

Crawford:   So  they  knew  about  the  problem,  and  they  had  even  analyzed  it? 


313 


Blum:      Even  analyzed  it. 

Crawford:   There  must  have  been  lots  of  development  money  at  that  time. 

Blum:      Oh,  yes,  there  was  plenty.   Well,  then  they  pulled  out  another 
chart  on  population,  and  all  by  province,  so  that  we  could  tell 
who  was  going  to  lose  population,  because  many  people  would 
leave  to  go  to  this  newly  irrigated  area  in  the  highlands. 

Of  course,  the  reason  the  highlands  were  not  really  already 
inhabited  was  the  historical  reality  of  prior  irrigation  from 
huge  tanks  which  were  hand-built  lakes  for  irrigation.   They 
had  already  irrigated  this  land  a  thousand  years  and  more  ago, 
and  had  to  abandon  it  because  malaria  got  so  bad.   This  high 
country  is  three,  four  thousand  feet  up,  and  they  could  grow 
everything  there,  and  the  heat  wasn't  so  terrific  as  in  the 
lower  altitude.   It  could  grow  many  of  the  crops  we  produce  in 
our  Central  Valley:  they  could  have  raised  fruits  and  all  kinds 
of  things  like  we  do  here,  and  that's  what  they  wanted  to  do. 

So  I  couldn't  believe  my  eyes  as  to  what  I  was  seeing, 
because  the  finance  ministry  had  anything  and  everything  I 
wanted,  and  a  hundred  things  more  that  I  didn't  want.   We  got 
it  all  down  in  chart  form;  I  handed  it  over  to  the  minister  of 
health,  who  was  the  kind  of  man  that  worked  about  twenty  hours 
a  day.   It  was  not  what  you  would  imagine  from  a  nice,  sleepy, 
supposedly  tropical  country.   He  was  a  brilliant  fellow. 

Crawford:   Who  was  he? 

Blum:      Weratunga,  Dr.  Weratunga.   He  was  something  else--a  family 

practitioner.   He  took  one  look  at  these  figures,  and  he  said, 
"My  god,  we're  going  to  have  more  people  in  the  hospital  than 
we  have  ever  had.   All  this  dirty  water,  and  they're  all  going 
to  be  drinking  it?   Something's  got  to  be  done." 

You  see,  there  were  economists  doing  the  planning,  and  they 
didn't  know  or  give  a  damn  about  health.   The  health  department 
wasn't  doing  anything;  he'd  just  inherited  the  job.   He  looked 
at  the  projections  and  saw  unmitigated  disaster  for  the  whole 
country.   The  finance  guy  I  had  met  at  the  party  had  seen  that 
already.   There  were  already  hospitals  full  of  contagious 
diseases . 

Crawford:   What  were  they  getting? 

Blum:      Well,  typhoid,  particularly,  and  dysentery. 

Crawford:   They  had  not  had  any  typhoid  prevention? 


314 

Blum:      Not  really,  untreated  water  keeps  it  going,  and  typhoid 

immunization  is  essentially  ineffective.   Then,  when  I  started 
visiting  the  hospitals,  I  discovered  that  many  of  them  were 
reinfecting  the  patients.   They'd  come  in  for  one  thing  and 
they'd  go  out  with  something  else.   They  didn't  have  clean 
water  in  many  hospitals. 

So  I  went  back  to  the  finance  department,  and  they  said, 
"Those  miserable  bastards."  That's  what  they  called  them. 
"They  won't  even  plan  for  building  a  water  system  for  each 
hospital.   We  have  been  on  their  trail  for  years  to  at  least 
have  clean  water  in  the  hospitals."  The  money  was  all  set 
aside.   "They  won't  use  it.   They're  all  for  great  new 
inventions  and  great  new  doctoring  and  they  send  out  people 
sick."   It  was  really  scandalous. 

Well,  then  I  walked  into  the  middle  of  some  interesting 
planning.   The  Health  Ministry,  further  on  down  the  ranks,  were 
not  aware  of  their  incompetence.   For  example,  the  hospital 
people  in  Colombo  wanted  to  import  a  German  laundry;  the  washer 
people—there '  s  a  word  for  them,  dhobies--were  all  out  in  the 
little  ditches  and  creeks,  which  are  potentially  full  of 
sewage,  doing  the  laundry.   But  the  truth  of  the  matter  is  if 
it  looked  clean,  they'd  just  fold  it  up  and  send  it  back.   All 
of  this  was  unsupervised.   You  pay  so  many  cents  per  sheet  or 
per  towel  or  whatever  it  is,  and  it  all  comes  back  to  the 
hospital  potentially  contaminated-- just  horrible.   But  what  the 
hospital  wanted  to  do  was  import  the  world's  finest  laundry. 

I  really  learned  a  lot  about  planning  in  Sri  Lanka.   They 
had  wonderful  planners  there,  and  the  upper  echelons  of 
government  were  pretty  savvy,  too.   They  had  a  scheme  they 
called  shadow  budgeting,  and  anything  they  held  really  dear  was 
given  new  values.   They  wanted  money  for  foreign  trade,  and  if 
your  department  could  save  on  that,  whatever  it  is  that  you 
wanted  to  do,  the  cost  was  cut  on  your  shadow  budget  according 
to  how  much  foreign  exchange  you  were  saving. 

For  instance,  instead  of  a  foreign-built  laundry,  I  figured 
out,  in  a  few  minutes,  what  they  could  do  for  the  dhobies,  the 
washer  people.   They  could  have  built  a  roof  over  their  heads 
and  could  have  pumped  in  clean  water—there  was  clean  water  in 
their  hospital  so  they  didn't  have  to  use  the  ditch  water  to 
wash  things  with.   They  could  have  a  supervisor  there  and  use 
Clorox/chlorine  to  sterilize  all  the  laundry;  they  could  have 
had  a  first-class  hand  laundry. 

Well,  the  shadow  budget  took  into  account  such  things  as 
the  cost  for  the  German  machine,  about  half  a  million  dollars, 


315 


not  counting  the  near  impossibility  of  ever  getting  it  fixed 
once  it  breaks. 

But  if  you  used  dhobies,  you  got  no  cost  shown  on  your 
budget  for  laundry.   You  got  that  free  because  it  was  a  largely 
unemployed  group  and  any  budget  helping  their  unemployment  got 
credit  for  that.   You  could  launder  the  sheets  for  a  fraction 
of  the  cost  by  using  hand  labor,  and  the  government  wanted  to 
employ  those  essentially  unskilled  people,  so  your  budget  costs 
were  nil. 

The  budget—the  country's  budget—was  built  that  way.   If 
you  had  to  buy  a  foreign  thing,  you  got  charged  double  or 
triple  because  you  were  using  up  foreign  exchange.   If  you  did 
something  that  was  wanted,  like  employing  the  unskilled,  it  was 
a  freebie  on  your  shadow  budget. 

This  was  brilliant,  this  shadow  budget.   You  want 
something—you  make  it  feasible.   You  don't  pay  for  your 
laundry  if  you  can  use  the  dhobies  to  do  it,  but  if  you  want 
the  German  machine--.   The  money  came  out  of  the  finance 
department.   You  could  be  taking  care  of  the  poor,  giving  them 
jobs,  yet  this  health  ministry  was  blindly  working  in  the 
opposite  direction.   They  were  going  to  take  the  jobs  away  from 
the  dhobi  and  send  the  money  to  Germany,  and  use  up  foreign 
exchange. 

So  on  that  basis,  the  health  department  was  persona  non 
grata  in  the  finance  department- -they  were  looked  upon  as 
abysmal  idiots.   The  sheets  would  cost  ten  cents  apiece  with  a 
German  laundry,  and  if  you  had  the  dhobies  do  them,  they  would 
cost  a  tenth  as  much.   The  fact  that  the  government  was  using 
their  own  valued  principles  to  juggle  the  budget  was  wonderful. 
It's  a  rare  country  that  does  that  in  a  meaningful  way. 

It  was  magnificent  planning.   Then  it  turned  out,  of 
course,  that  there  were  big  budgets  for  clean  water  in  the 
hospitals  that  were  never  used.   This  health  director  was 
appointed  just  as  I  got  there,  and  he  was  losing  his  mind  over 
this,  because  he  could  see  all  this  horrible  stuff  going  on, 
and  he  was  stuck  with  all  these  fine  old  employees  who  did  as 
little  as  possible  and  never  cared.   It  was  a  really  crummy 
system  of  management  for  a  remarkably  equitable  service  that 
covered  all  persons  in  the  country. 

The  finance  department  had  an  input /output  measurement  of 
everything  that  was  made  in  the  country  or  brought  in,  and 
where  it  went,  what  it  was  used  for.   I  don't  know  if  there's 
another  country  in  the  world  that  really  has  that.   But  I  went 


316 


Crawford: 


Blum: 


Crawford: 
Blum: 


to  the  library  in  the  Department  of  Finance,  and  I  discovered 
that  the  Colombo  hospital  could  have  the  chlorine  for  its 
laundry  essentially  for  free,  because  industry  in  Sri  Lanka  was 
decomposing  sea  water—the  salt  part  —  into  sodium,  which  they 
wanted  for  something,  and  the  chlorine  they  had  to  dump  back 
out  in  the  ocean.   So  it  could  have  been  used  for  free  if  the 
health  department  wished  to  disinfect  the  hospital  laundry 
while  it  was  being  done  by  the  dhobies. 

Well,  this  is  what  planners  do,  and  finally  1  had  my 
meeting  with  all  the  ministry  people. 

I  read  that  there  were  members  of  parliament  at  this  conference 
in  Sri  Lanka. 

Yes,  high  level  people.   I  handed  them  twenty-five  or  thirty 
highly  desired  national  objectives  that  I  had  culled  out  of  the 
newspapers,  and  one  of  them  was  productivity.   That  was  number 
one,  as  far  as  I  could  remember,  and  number  two  was  something 
else.   Number  three  was  respect  or  care  for  the  elderly,  and  so 
on. 

I  asked  them  about  the  list,  throwing  it  out  as  what  the 
foreigner  would  see  in  the  newspapers  as  national  goals. 
"These  are  the  things  you  care  about.   How  about  it?"  They 
said,  "Yes,  yes,  that's  a  good  list." 

I  said,  "There  are  some  problems  here  with  this  list.   If  I 
plan  for  the  health  sector,  and  if  we  hold  the  care  for  the 
elderly  up  there  very  high,  as  you  do,  there's  not  going  to  be 
as  much  money  for  the  productivity  goal.   The  productivity 
sector  includes  people  of  different  ages,  and  the  money  has  got 
to  be  spent  in  different  ways  for  different  things,  for  folks 
in  the  productive  age.   How  do  you  feel  about  that?"   Here  you 
have  two  values,  and  they're  competing  with  one  another. 
That's  typical  of  all  countries  and  how  their  values  affect 
planning. 

They  decided  that  the  elderly  would  come  first.   Principles 
are  principles,  but  values  are  values,  and  for  them,  these  came 
first.   We  went  through  the  list,  and  a  lot  of  concerns  shook 
out.   It  was  fun.   At  least  you  got  a  feel  that  they  were 
responding.   I'm  planning  for  them,  but  am  I  going  to  plan  for 
productivity  or  going  to  plan  for  the  elderly?  They  had  to 
make  decisions  relevant  to  their  value  schema. 

You  only  have  so  much? 

A  country  has  only  so  many  available  resources. 


317 


Crawford: 

Blum: 


Crawford: 
Blum: 


Crawford: 
Blum: 


It  was  an  interesting,  rather  equitable  country.   At  that 
time,  everybody  got  a  weekly  rice  ration.   It's  the  only 
country  in  the  world  that's  ever  done  that,  as  far  as  I  know, 
and  it  bankrupted  them.   They  had  to  give  it  up. 

They  got  into  lots  of  problems  over  it--it  is  not  a 
communist  country;  not  a  socialist  country—they  just  felt  very 
strongly  about  how  things  should  be.   You  say,  "Why  don't  you 
just  give  it  to  the  poor?"  They  say,  "Then  we'd  have  to  pick 
out  the  poor,  and  make  them  feel  poor."  The  whole  business  of 
putting  the  finger  on  people  for  some  demeaning  reason  was 
unacceptable. 

Discriminating. 

Discriminating,  yes.   I  was  very  impressed  with  this,  yet  saw 
that  it  was  high-level  politics  that  had  been  costing  the 
country  a  bundle  of  money  that  was  not  there  to  be  spent. 

They  had  kind  of  overdone  the  health  sector  that  way,  too. 
They  had  promised  everybody  health  services,  so  that  for  the 
average  person  it  was  available  within  minutes  all  over  the 
country.   They  had  equally  invested  in  the  educational  sector 
and  in  transportation. 

It  was  a  real  priority.   Is  it  still? 

I  can't  tell  you.   I  don't  know.   I  suspect  it  is.   There  are 
things  that  you  can't  give  up  that  easily,  as  Mrs.  Margaret 
Thatcher  found  out.   But  one  of  the  crazy  things  is  that  they 
had  so  much  respect  for  individuals  that  they  had  two  systems: 
the  ayurvedic  system  and  the  Western  system  of  medical  care. 
Everybody  had  a  choice  or  could  use  both.   You  go  anywhere  in 
the  country  and  you  come  to  a  free  health  station,  and  there 
would  be  the  Western  or  the  ayurvedic--rarely  together,  though 
--they  were  usually  separate. 


What  is  the  ayurvedic  system? 


So 


It  came  from  India.   It  was  longstanding—is  still  there, 
there  was  the  free  government  program  and  a  private  pay 
program,  so,  potentially,  in  any  one  neighborhood,  you  had  four 
kinds  of  practitioners  —  a  public  and  a  private  practitioner  in 
both  Western  and  ayurvedic  medicine. 

It  was  a  needlessly  expensive  system.   I  visited  Western- 
type  clinics  with  three  or  four  young  docs  with  nothing  to  do- 
maybe  an  occasional  delivery.   Well,  that's  insanity.   You 
wreck  the  doctors  because  they're  not  doing  anything.   You  make 


318 


them  kind  of  unruly  because  they're  feeling  neglected  and 
wasted. 

II 

Blum:      And  why  should  people  stop  locally  for  care?  For  three  cents 
they  can  go  down  to  Colombo  to  the  medical  school  where  there 
is  a  big  hospital,  fancy  docs,  the  works.   Besides,  they  get  to 
visit  and  shop  in  Colombo.   The  care  costs  them  nothing  there 
and  it  costs  them  nothing  here. 

A  planner  should  take  many  things  into  account:  how  good 
and  how  cheap  the  transportation  is  becomes  a  factor  in  health 
care,  because  folks  are,  if  they're  human  beings,  going  to  go 
downtown  if  the  fare  is  three  cents  and  get  their  medical  care, 
even  as  they  continue  to  live  out  of  town.   Well,  this  is  what 
planning  is  all  about,  you  see. 

Crawford:   You  really  have  to  know  that  culture. 

Blum:      You've  got  to  know  the  culture,  the  practices;  you've  got  to 
know  the  country.   Then  you  have  to  explain  it  to  the 
officialdom  and  the  legislators,  so  they  can  make  the  right 
policies . 

So  here  was  the  country  being  undermined  by  a  very  generous 
set  of  policies—very  generous.   And  a  good  education-- 
everybody  got  educated  better  there  than  is  the  case  here. 

I  sat  in  on  a  couple  of  Commonwealth  academic  examining 
boards.   One  was  the  architectural  board,  whose  members  come 
from  Britain  and  hold  the  exams  for  the  graduating  class. 
There's  nothing  shaky  about  architecture  in  Britain,  and  the 
same  way  of  examining  goes  on  in  medicine.   This  is  the 
valuable  aspect  of  being  an  active  Commonwealth  country  and 
this  is  reproducing  Europe  abroad.   However,  it  has  no  respect 
for  the  native  culture,  or  for  the  nation's  needs.   This  is  the 
sad  part,  you  see.   They  could  go  all  through  the  medical  care 
examinations  or  architecture  and  never  notice  that  the  patients 
in  the  hospitals  were  there  for  contagious  diseases  that  never 
should  have  been,  and  that  many  hospitals  did  not  provide 
potable  water  to  their  patients. 

By  contrast,  seven  years  later,  I  was  wandering  through 
China,  and  I  went  to  visit  a  large  hospital  in  Shanghai.  The 
pediatrics  ward  was  essentially  empty.  We  asked,  "Where  are 
your  patients?"  They  said,  "Well,  we  don't  really  have  many 
children  patients  —  they  're  immunized  for  this,  and  this,  and 
this."  They're  better  immunized  than  our  children  are.  That 


319 


was  true  then;  I  doubt  if  it's  true  now.   It's  slipping  now, 
they're  becoming  more  like  us  in  their  quest  for  a  market 
society. 

They  said,  "What  we  have  here  are  some  thyroid  problems,  we 
have  some  tumors,  we  have  this  and  that,  but  it  doesn't  keep 
the  wards  full  anymore.   We  don't  have  diphtheria,  we  don't 
have  tetanus,  we  don't  have  whooping  cough  or  measles.   We  just 
don't  have  the  things  that  used  to  fill  the  hospitals  up." 

This  was  looking  at  the  origins  of  illness  in  China. 
There,  in  Sri  Lanka,  they  were  just  building  beds  and  training 
M.D. 's. 


Crawford:   What  happened?  Did  they  take  notice  of  your  findings? 
were  there  for  about  three  months? 


You 


Blum: 


Crawford: 


Blum: 


I  don't  know.   I  don't  think  so.   Yes,  three.   I  don't  think 
anything  happened  at  all.   While  I  was  there  they  gave  up  on 
mosquito  control,  and  they  had  the  most  horrible  outbreak  of 
malaria  the  next  year.   They  weren't  really  listening  to 
anybody.   This  was  WHO  sending  a  planner.   If  I'd  have  stayed 
with  the  health  ministry—but  you've  got  to  be  there  for  a 


couple  of  years  to  have  an  impact, 
in  and  leave  a  plan. 


There's  no  way  you  can  come 


Were  you  impressed  with  any  of  the  other  development  efforts 
that  were  going  on? 

The  planning  effort,  which  was  interesting,  had  been  instituted 
by  a  queer  combination.   An  Israeli  and  an  Egyptian  set  up  all 
that  wonderful  planning  that  I  described  for  the  finance 
department,  but  at  that  point,  the  Sri  Lankans  kicked  out  the 
Israelis . 

I,  it  so  happened,  had  come  into  the  country  with  some 
Egyptians,  and  was  actually  in  the  Egyptian  enclave.   They  knew 
perfectly  well  that  I  was  Jewish,  but  I  spent  much  of  my  spare 
time  with  the  Egyptians,  and  the  man  that  I  was  with  was  the 
equivalent  of  the  ambassador.   He  was  the  head  of  the  trade 
mission  there. 

He  told  me  a  sad  story:  "You  know,  all  the  Israelis  are 
kicked  out,  and  the  other  day  I  saw  this  ad  in  the  paper  for 
some  second-hand  furniture  being  sold  from  a  home."  He  said, 
"I  went  out  there  to  see  it,  and  it  was  just  what  I  wanted.   It 
turned  out  it  was  the  Israeli  planning  director's  home,  and  did 
I  ever  feel  awful  to  even  be  seen  in  a  situation  like  that. 
This  Israeli  is  kicked  out  of  the  country,  so  here  this 


320 


Egyptian  comes  in  and  takes  all  of  his  furniture, 
couldn't  get  out  of  there  fast  enough." 


Horrible.   I 


These  were  very  alert  Egyptians,  and  it  startled  me--how 
similar  they  were  to  Jews.   They  were  cultured  in  the  same  way, 
interested  in  the  arts,  social  justice,  and  the  whole  shebang. 
I  fitted  right  in  with  them.   I  don't  believe  that  ever  before 
or  since  have  I  really  become  that  close  to  people  in  such  a 
short  time.   We  actually  were  all  in  tears  when  we  left.   They 
got  us  a  place  to  live  in  and  did  everything  for  us.   I  suppose 
we  were  near-alikes  in  a  foreign  culture. 

Crawford:   Your  wife  went,  as  well? 

Blum:      Oh,  yes.   I  never  go  anywhere  without  her. 

Crawford:   You  said,  last  time  when  we  talked,  that  there  was  quite  a  bit 
of  fraud—if  not  fraud,  you  found  a  lot  of  obstacles  on  these 
assignments? 

Blum:      Oh,  yes,  this  one  wasn't  particularly  fraud.   It  was  an  old  way 
of  doing  business  that  nobody  ever  looked  at.   Some  people 
never  did  a  day's  work,  but  that  was  typical  not  just  of  that 
country,  but  of  many  countries  including  this  one.   There  you 
were  up  against  long-standing  things,  and  if  you  got  hired  for 
three  months,  you  knew  there  was  no  serious  intent  for  you  to 
make  significant  change. 

Crawford:   Really? 

Blum:      How  could  there  be?   You're  talking  about  undoing  hundreds  of 

years  of  the  ways  a  culture  operates  to  produce  good  education, 
good  transport. 

Crawford:   Did  they  tie  you  up  with  a  counterpart  in  the  field? 

Blum:      Yes,  there  was  a  chief  of  planning  for  the  health  ministry,  and 
he  was  assigned  to  planning  because  he  was  the  worst  medical 
officer  they  had;  they  just  couldn't  find  a  worse  one.   So  I 
had  him  as  my  counterpart.   He  didn't  know  what  we  were  doing, 
he  didn't  care,  he  never  came  to  work—he  was  a  total  bum.   So 
they  unloaded  him  on  me  because  they  didn't  want  him  in  surgery 
or  obstetrics. 

Crawford:   What  could  the  government  of  Sri  Lanka  hope  for? 

Blum:      Well,  I  don't  know  what  they  expected  of  me.   These  are  always 
the  great  mysteries.   Maybe  they  could  get  somebody  to  do 
something  they  wanted. 


321 


Weratunga  probably  went  to  work  on  that  potential  dirty 
water  catastrophe;  he  was  no  slouch,  but  he  ended  up,  in  short 
order,  leaving  the  ministry.   He  became  the  ambassador  to 
Russia.   He  was  a  very,  very  impressive  man. 

He  was  a  Sinhalese.  The  other  really  impressive  man  I  met 
was  a  Tamil,  the  dean  of  the  medical  school  in  Kandy.  That  was 
the  new  school.  He  was  also  their  representative  to  WHO--a  man 
who  was  on  the  go.  He  died  of  a  heart  attack  as  a  young  man. 

He  was  a  perfectionist,  and  he  pushed  the  country  into 
creating  a  formulary  or  list  of  the  kinds  of  drugs  that  would 
be  allowed  into  the  country  and  made  available.   In  contrast  to 
most  free-market  countries,  you  couldn't  just  ship  any  old 
drugs  into  Sri  Lanka--he  managed  to  sell  this  idea  of  "useful" 
drugs.   So  they  had  perhaps  a  hundred  useful  drugs  imported, 
and  other  than  that—no.   The  manufacturers  had  to  meet  a  sort 
of  price  guide  and  everything.   It  was  a  beautiful  job. 

There  are  almost  no  other  countries  like  that—Nordics 
excepted,  but  it's  not  anything  I'm  used  to,  for  the  most  part. 
He  happened  to  be  an  M.D.,  and  a  pharmacologist,  and  the  dean 
of  a  medical  school— wonderful  man. 

I  remember  we  went  to  visit  his  home,  up  in  Kandy,  a 
beautiful  home  in  beautiful  country:  everything's  green  and 
there  are  all  kinds  of  trees,  and  the  climate  is  such  that  you 
have  tropical  and  nontropical  weather. 

I  said  to  him— he  hadn't  been  dean  too  long— "How  did  you 
get  such  a  beautiful  home."  He  said,  "I  was  lucky.   I  was  very 
lucky.   The  man  who  used  to  have  this  home  was  a  professor 
here,"  he  said.   It's  the  kind  of  place  where  the  grounds  come 
right  up  to  the  door,  and  you  walk  right  into  the  house— there 
are  no  barriers,  you  know.   He  said  the  professor  came  in  and 
went  to  get  one  of  his  favorite  books  and  he  pulled  out  a  viper 
along  with  it."   It  was  just  a  small  thing,  but  it  was 
poisonous— they ' re  widespread.   We  even  saw  them  on  a  cruise  in 
the  Greek  Islands. 

"He  went  off  running,"  he  said,  "and  he's  never  been  seen 
since.   He  left  the  country.   So  his  house  was  standing  here, 
and  I  took  it."   [laughter] 

After  I'd  been  there,  a  Sri  Lankan  came  to  visit  us  here, 
and  we  took  him  to  dinner  in  the  city.   I  mentioned  this  tale 
about  the  snake- -he  also  lived  in  Kandy,  he  was  from  the 
university  there— and  he  got  quite  upset  with  me  for  being 
derisive  about  living  with  all  these  poisonous  snakes.   He 


322 


Crawford: 


said,  "We  have  a  home  in  Kandy,  and  I  have  little  children,  and 
my  daughter  has  a  pet  cobra  out  in  the  backyard.   You  just 
don't  interfere  with  them.   It's  part  of  living  there."   So  you 
get  another  side  of  how  people  live. 

One  night  in  Colombo,  we  went  to  visit  some  Canadians 
stationed  there,  and  were  living  in  a  magnificent  home.   They 
had  beautiful  furniture-- just  exquisite,  a  lot  of  rich  woods 
and  things.   Then  these  smooth  floors  and  giant  doors,  maybe 
fifteen  feet  across,  which  slide  open,  and  the  house  is  open  to 
the  yard. 

Under  every  seat  at  this  dinner  were  mosquito  coils  and 
they  were  all  stinking  away  so  that  the  smoke  was  drifting 
around  and  thus  the  mosquitos  wouldn't  eat  you.   There  were 
three  or  four  significant  diseases  that  they  carried  there. 

The  hostess  said,  "Out  there  in  the  backyard"--which  is 
just  behind  where  Marian  and  I  are  sitting—she  said,  "the 
little  neighborhood  girl  came  over  and  was  looking  at  the  plum 
tree.   As  she  was  taking  a  plum  she  saw  this  giant  cobra.   She 
came  running  into  the  house  to  tell  me  that  we  had  this  giant 
cobra  in  our  backyard." 

So,  Marian  and  I  were  sitting  over  a  mosquito  coil,  and  of 
course  it's  getting  dark.   It  is  dark—in  the  tropics  it  gets 
dark  fast.   We  spent  the  evening  hoping  that  those  people 
facing  the  yard  will  see  anything  out  in  the  yard  headed  our 
way,  because  we  can't.   [laughs] 

Did  you  feel  badly  that  the  result  of  your  work  was  less  than 
dramatic? 


Blum:      I  couldn't.   I  don't  think  you're  ever  asked  to  take  that  to 

heart.   In  fact,  you're  encouraged  to  be  relaxed  about  it--just 
like  medical  care--you  can't  take  every  patient  too  much  to 
heart  or  you'll  lose  your  mind. 

Crawford:   Did  WHO  do  follow-ups? 

Blum:      I  haven't  the  faintest  idea.   I  doubt  it.   The  WHO  regional 
director  general  was  a  Sri  Lankan.   He  was  a  useless  bum. 
Nobody  had  any  respect  for  him,  at  all.   He  was  the  big  boss 
for  WHO  for  the  whole  region—that  part  of  the  world. 

It's  an  interesting  thing:  the  director  general  in  Geneva 
does  not  select  the  assistant  director  generals  for  the 
regions.   They  are  voted  upon  by  the  countries  in  the  region. 
So  you  get  what  you  get,  and  that's  that. 


323 


The  director  generals,  who  for  the  most  part  had  been  very 
remarkable  people,  I  think,  were  not  necessarily  well- 
represented  out  there  in  the  country.   However,  the  regional 
director  was  very  close  to  everything  we  did.   He  was  always 
home,  and  since  he  never  did  anything,  I  don't  think  he  cared 
whether  we  ever  did  anything. 


Blum:      I  believe  that  Sri  Lanka  fascinated  me  for  several  quite 

different  reasons.   It  was  the  tropics  with  a  discrete  society 
for  2,000  or  more  years  under  three  European  colonial 
dynasties.   It  emerged  with  an  educated,  proud  people,  well 
grounded  in  humane  practices,  ahead  of  us  in  many  ways.   But  in 
retrospect  it  makes  me  ill  to  see  how  they  destroyed  themselves 
with  essentially  no  outside  help  in  some  twenty-five  years. 

The  Sinhalese,  80  percent  of  the  population,  came  from 
northwest  India  about  2,000  years  ago.   They  are  a  tall, 
handsome,  fairly  light-skinned  people  who  were  never  fully 
conquered  and  are  proud  of  their  heritage.   The  Tamils,  a 
smaller,  very  dark-skinned  group,  came  about  150  years  ago  from 
the  neighboring  Indian  province,  primarily  to  work  in  the 
British  tea  plantations  in  the  highlands.   They  ended  up  being 
to  the  Sinhalese  what  blacks  are  to  whites  in  the  U.S. 

When  I  was  there,  a  very  elaborate  national  birth  control 
program  was  abandoned  because  the  Sinhalese  claimed  that  it  was 
going  to  be  genocide  for  them,  the  80  percent  majority,  because 
the  poor  Tamils  who  made  up  17  percent  of  the  population 
wouldn't  use  birth  control.   They  also  felt  that  the  Tamils 
weren't  worthy  people,  primarily  because  they  worked  too  hard. 

A  minority  is  apparently  always  a  minority  for  some  so- 
called  good  reason.   Discrimination  was  widespread,  and  the 
Tamils  simply  revolted,  wanting  a  piece  of  the  country  for 
their  own.   The  resulting  civil  war  has  shown  just  how 
determined  the  Tamils  can  be,  and  everything  in  Sri  Lanka  is  a 
mess.   Planning  seems  to  be  pointless  in  the  pressure  of  deep- 
seated  prejudices.   These  are  lovely  people,  proud,  self- 
sufficient,  yet  being  wasted  by  their  own  unharnessable 
prejudices. 


324 


WHO  and  a  Planning  Handbook 


Blum:      Also  in  1970  I  was  asked  to  prepare  a  draft  "on  how  to  plan  for 
health"  for  WHO.   I  had  a  few  months  to  prepare  it  and  then 
came  to  Geneva  to  present  it  to  an  international  committee 
whose  members  would  critique  it  for  several  days,  after  which  I 
would  take  it  home  to  rewrite  it,  and  it  would  (and  did)  become 
the  official  guide  of  WHO  on  how  to  plan  for  health. 

WHO's  central  offices  in  Geneva  are  an  impressive  sight, 
and  the  meeting  chambers  are  truly  elegant  and  functional. 
Each  speaker  is  simultaneously  translated  into  English,  French, 
Russian,  and  Spanish,  and  into  other  languages  when 
participants  require  it. 

We  worked  for  two  hours  at  a  stretch  four  times  a  day, 
after  getting  a  sendoff  by  a  WHO  spokesperson  and  by  whomever 
was  appointed  as  the  chair  for  the  task. 

Criticisms  were  generally  given  in  a  polite  but 
understandable  way  by  the  participants.   Early  in  the  first  day 
I  received  a  rather  significant  criticism  by  a  well-known 
Hungarian  planner.   Unfortunately,  he  had  found  a  very  weak 
spot  in  my  writing  that  was  contradicted  by  my  main  thesis. 
Almost  immediately  I  found  myself  being  defended  by  various 
members  from  the  Western  bloc  because  the  critic  was  part  of 
the  Russian  bloc.   I  noted  his  comments  and  made  use  of  them, 
but  it  was  clear  that  my  supporters  were  less  interested  in  the 
significance  of  the  criticisms  than  in  their  source. 

That  evening  I  was  rounded  up  for  dinner  by  the  Western 
bloc  folks  in  a  session  free  of  any  Russian  bloc  people.   This 
made  the  job  a  lot  easier,  but  probably  a  bit  less  rigorous. 

During  the  three  working  days,  the  Russian  representative, 
who  was  a  huge,  dour,  handsome  man  in  charge  of  training  all 
health  planners  in  Russia,  and  was,  1  was  told,  the  surgeon 
general  of  the  Russian  army  in  World  War  II  only  spoke 
occasionally.   His  contribution  was  usually  translated  into  the 
same  message:  "Gentlemen,  let  us  not  be  so  didactic,  there  is 
no  one  right  way  to  do  things.   In  my  own  country  we  just  can't 
use  one  way  of  planning  for  anything."   I  found  this  very 
refreshing  and  wise,  and  took  heed  in  my  rewrite.   But 
interestingly  enough,  our  Western  bloc  dinner  group  concluded 
that  the  Russian  was  so  dogmatic  and  could  only  see  things  in 
one  light.   True,  his  little  speeches  were  very  similar  to  one 
another,  but  their  intent  was  obviously  to  get  away  from  hard 


325 


and  fast  planning  rules  that  would  probably  be  destructive  much 
of  the  time  if  applied. 

I  learned  that  Russia  was  training  several  thousand  health 
planners  every  year;  knowing  that  they  did  make  big  top-down 
plans,  I  wondered  where  all  the  planners  could  be  utilized.   At 
a  morning  tea  I  asked  the  Russian  translator  to  ask  the  Russian 
on  our  committee  what  they  did  with  so  many  planners.   Without 
turning  to  look  at  me  or  skip  a  sip  of  tea,  the  Russian  planner 
said,  "Tell  him  I'll  loan  him  a  thousand  planners  any  time  he 
wants  them."  This  more  than  confirmed  my  guess  that  they  had 
gone  overboard  on  turning  out  planners  and  that  the  head  of 
Russian  health  planner  training  was  all  too  aware  of  that 
reality. 

These  were  educational  events  for  me  and  1  had  the  good 
fortune  to  do  more  such  study  efforts  for  WHO  in  Geneva,  in 
Copenhagen,  in  Santiago,  in  Washington,  D.C.,  in  New  Orleans, 
in  Gothenberg,  and  in  The  Hague. 

At  my  last  such  event  in  The  Hague,  the  participants  and 
speakers  were  to  be  received  by  Queen  Beatrix  at  a  tea  on  the 
last  day.   I  came  down  with  food  poisoning  and  couldn't  go,  my 
wife  had  to  go  to  uphold  our  end.   The  Queen  greeted  everyone 
at  the  entry  to  the  palace,  in  their  own  language.   When  my 
wife  was  introduced,  she  immediately  commiserated  with  her 
about  her  sick  husband.   When  the  affair  broke  up,  the  Queen 
sought  her  out  and  extended  her  best  wishes.   For  truly  down- 
to-earth  plebeians  as  my  wife  and  I  both  are,  this  encounter 
rather  undermined  our  long-standing  antimonarchial  biases. 


Assignments  in  South  America  with  the  Pan  American  Health 
Organization 


Blum:      PAHO  gave  me  another  assignment,  this  one  a  lot  more  tangible 
and  highly  relevant  to  their  and  my  own  interests.   Dr.  John 
Hastings  of  the  University  of  Toronto  who  had  carried  on  a 
tremendous  study  of  the  desirability  and  success  of  combined 
human  services  was  my  teammate  for  examining  what  the  merits 
might  be  for  the  success  of  combining  human  services  in 
Colombia,  which  had  just  emerged  from  its  seemingly  endless 
savageries,  and  to  us  outsiders  looked  as  though  it  were 
actively  drifting  towards  perpetual  disaster.   We  met  with  the 
ministers  of  health  and  welfare  and  the  dean  of  the  School  of 
Public  Health  and  some  very  wealthy  and  politically  powerful 
business  women  and,  above  all,  with  liberation  theologists  who 


326 


were  risking  their  lives  to  help  straighten  out  the  country's 
massive  injustices.   The  priests,  using  their  Catholic  church's 
authority,  were  espousing  the  idea  of  doing  God's  work  in  the 
here  and  now,  not  just  in  the  hereafter--an  appealing  notion. 

We  stayed  at  the  exquisite  Tecondama  Hotel  which  turned  out 
to  have  its  problems.   One  was  our  experience  as  the  doorman 
turned  us  over  to  the  chauffeur  of  the  Ministry  of  Health  car 
taking  us  to  dinner  with  the  minister.   The  doorman  was  flanked 
in  the  bustling  street-sidewalk  mess  of  a  large  hotel  by  two 
police  armed  with  submachine  guns.   In  the  time  it  took  for  us 
to  cover  four  feet  and  get  into  the  car,  our  chauffeur  suddenly 
screamed.   Someone  had  stripped  off  his  wristwatch  as  he  was 
handing  us  in  with  his  other  arm.   From  that  time  on  we  were 
regaled  with  fearsome  tales  of  how  the  poor  outwitted  the  more 
affluent.   Everyone  seemed  to  enjoy  recounting  the  picaresque 
doings  of  the  growing  class  of  criminals,  who  were  no  longer 
necessarily  just  the  poor. 

We  got  to  Cali  on  invitation  of  the  new  medical  school 
there  whose  dean  I  had  met  at  a  PAHO  meeting  in  the  U.S.   This 
was  an  interesting  city  at  the  center  of  old  estates,  large 
blocks  of  undeveloped  land  being  in  individual  hands,  like  our 
Texas.   As  we  entered  town  we  saw  vehicles  upside  down,  on 
fire,  wheels  rotating  with  tongues  of  flame.   Some  young  people 
and  a  few  troops  occasionally  appeared.   This  was  the  first  day 
of  a  strike  by  students  at  the  medical  school,  a  strike  that 
spread  and  finally  closed  the  whole  university,  a  fairly 
liberal  enclave,  for  a  year  and  more. 

In  South  America,  medical  students  came  primarily  from 
wealthy  families  and  so  a  strike,  over  social  causes,  is  an 
interesting  situation  in  which  few  student  strikers  were  likely 
to  be  hurt. 

I  was  brought  to  our  meeting  place,  away  from  campus,  and 
we  had  an  afternoon  presentation  by  an  American  systems 
theorist.   He  described  his  introduction  of  systemic 
relationships  to  second-year  medical  students.